Ion beam kinetic energy dissipater apparatus and method of use thereof

ABSTRACT

The invention comprises a method and apparatus for reducing a kinetic energy of positively charged particles, comprising the steps of: (1) transporting the positively charged particles from an accelerator into an exit nozzle system along a beam line; (2) providing a first chamber of the exit nozzle system, the first chamber comprising: an incident side comprising an incident aperture, an exit side comprising an exit aperture, and a beam path of the positively charged particles from the incident aperture to the exit aperture; (3) filling the beam path in the chamber with a liquid; and (4) using the liquid to reduce the kinetic energy of the positively charged particles. The kinetic energy dissipater is optionally used in combination with a proton therapy cancer treatment system and/or a proton tomography imaging system.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/467,840 filed Mar. 23, 2017, which is a continuation-in-partof U.S. patent application Ser. No. 15/402,739 filed Jan. 10, 2017,which is a continuation-in-part of U.S. patent application Ser. No.15/348,625 filed Nov. 10, 2016, which is a continuation-in-part of U.S.patent application Ser. No. 15/167,617 filed May 27, 2016.

BACKGROUND OF THE INVENTION Field of the Invention

The invention relates generally to controlling an ion beam, such as forimaging and treating a tumor.

Discussion of the Prior Art Cancer Treatment

Proton therapy works by aiming energetic ionizing particles, such asprotons accelerated with a particle accelerator, onto a target tumor.These particles damage the DNA of cells, ultimately causing their death.Cancerous cells, because of their high rate of division and theirreduced ability to repair damaged DNA, are particularly vulnerable toattack on their DNA.

Patents related to the current invention are summarized here.

Proton Beam Therapy System F. Cole, et. al. of Loma Linda UniversityMedical Center “Multi-Station Proton Beam Therapy System”, U.S. Pat. No.4,870,287 (Sep. 26, 1989) describe a proton beam therapy system forselectively generating and transporting proton beams from a singleproton source and accelerator to a selected treatment room of aplurality of patient treatment rooms.

Problem

There exists in the art of charged particle cancer therapy a need foraccurate, precise, and rapid imaging of a patient and/or treatment of atumor using charged particles.

SUMMARY OF THE INVENTION

The invention comprises control of energy of a charged particle beam,such as in a cancer imaging/treating apparatus and method of usethereof.

DESCRIPTION OF THE FIGURES

A more complete understanding of the present invention is derived byreferring to the detailed description and claims when considered inconnection with the Figures, wherein like reference numbers refer tosimilar items throughout the Figures.

FIG. 1A illustrate component connections of a charged particle beamtherapy system, FIG. 1B illustrates a charged particle therapy system;

FIG. 2 illustrates a tomography system;

FIG. 3 illustrates a beam path identification system;

FIG. 4A illustrates a beam path identification system coupled to a beamtransport system and a tomography scintillation detector; FIG. 4Billustrates an x-axis ionization strip detector; FIG. 4C illustrates ay-axis ionization strip detector; FIG. 4D illustrates a kinetic energydissipation chamber; FIG. 4E illustrates ionization strips integratedwith the kinetic energy dissipation chamber; FIG. 4F illustrates analternating kinetic energy dissipation chamber—targeting chamber; FIG.4G illustrates a beam mapping chamber; FIG. 4H illustrates beamdirection compensating chambers; and FIG. 4I illustrates thescintillation detector rotating with the patient and gantry nozzle;

FIG. 5 illustrates a treatment delivery control system;

FIG. 6A illustrates a two-dimensional—two-dimensional imaging systemrelative to a cancer treatment beam, FIG. 6B illustrates multiple gantrysupported imaging systems, and FIG. 6C illustrates a rotatable conebeam;

FIG. 7A illustrates a process of determining position of treatment roomobjects and FIG. 7B illustrates an iterative position tracking, imaging,and treatment system;

FIG. 8 illustrates a fiducial marker enhanced tomography imaging system;

FIG. 9 illustrates a fiducial marker enhanced treatment system;

FIGS. 10(A-C) illustrate isocenterless cancer treatment systems;

FIG. 11 illustrates a transformable axis system for tumor treatment;

FIG. 12 illustrates a semi-automated cancer therapy imaging/treatmentsystem;

FIG. 13 illustrates a system of automated generation of a radiationtreatment plan;

FIG. 14 illustrates a system of automatically updating a cancerradiation treatment plan during treatment; and

FIG. 15 illustrates an automated radiation treatment plan developmentand implementation system.

Elements and steps in the figures are illustrated for simplicity andclarity and have not necessarily been rendered according to anyparticular sequence. For example, steps that are performed concurrentlyor in different order are illustrated in the figures to help improveunderstanding of embodiments of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The invention comprises a method and apparatus for reducing a kineticenergy of positively charged particles, comprising the steps of: (1)transporting the positively charged particles from an accelerator intoan exit nozzle system along a beam line; (2) providing a first chamberof the exit nozzle system, the first chamber comprising: an incidentside comprising an incident aperture, an exit side comprising an exitaperture, and a beam path of the positively charged particles from theincident aperture to the exit aperture; (3) filling the beam path in thechamber with a liquid; and (4) using the liquid to reduce the kineticenergy of the positively charged particles.

The above described embodiment is optionally used in combination with aproton therapy cancer treatment system and/or a proton tomographyimaging system. Generally, one or more detectors imaging photons emittedfrom the coated layers, also referred to as imaging sheets or layers,are used to determine one or more point positions of the chargedparticle beam at a given time. Combining the point positions yieldslocalized vectors pinpointing the charged particle beam position, suchas entering a patient. The resulting charged particle statedetermination system using one or more coated layers is used inconjunction with a scintillation detector or a tomographic imagingsystem at time of tumor and surrounding tissue sample mapping and/or attime of tumor treatment where common synchrotron, beam transport, and/ornozzle elements are used for both proton imaging and cancer treatment.

The above described embodiment is optionally used in combination with aset of fiducial marker detectors configured to detect photons emittedfrom and/or reflected off of a set of fiducial markers positioned on oneor more objects in a treatment room and resultant determined distancesand/or calculated angles are used to determine relative positions ofmultiple objects or elements in the treatment room. Generally, in aniterative process, at a first time objects, such as a treatment beamlineoutput nozzle, a specific potion of a patient relative to a tumor, ascintillation detection material, an X-ray system element, and/or adetection element, are mapped and relative positions and/or anglestherebetween are determined. At a second time, the position of themapped objects is used in: (1) imaging, such as X-ray, positron emissiontomography, and/or proton beam imaging and/or (2) beam targeting andtreatment, such as positively charged particle based cancer treatment.As relative positions of objects in the treatment room are dynamicallydetermined using the fiducial marking system, engineering and/ormathematical constraints of a treatment beamline isocenter is removed.

In combination, a method and apparatus is described for determining aposition of a tumor in a patient for treatment of the tumor usingpositively charged particles in a treatment room. More particularly, themethod and apparatus use a set of fiducial markers and fiducialdetectors to mark/determine relative position of static and/or moveableobjects in a treatment room using photons passing from the markers tothe detectors. Further, position and orientation of at least one of theobjects is calibrated to a reference line, such as a zero-offset beamtreatment line passing through an exit nozzle, which yields a relativeposition of each fiducially marked object in the treatment room.Treatment calculations are subsequently determined using the referenceline and/or points thereon. The inventor notes that the treatmentcalculations are optionally and preferably performed without use of anisocenter point, such as a central point about which a treatment roomgantry rotates, which eliminates mechanical errors associated with theisocenter point being an isocenter volume in practice.

In combination, a method and apparatus for imaging a tumor of a patientusing positively charged particles and X-rays, comprises the steps of:(1) transporting the positively charged particles from an accelerator toa patient position using a beam transport line, where the beam transportline comprises a positively charged particle beam path and an X-ray beampath; (2) detecting scintillation induced by the positively chargedparticles using a scintillation detector system; (3) detecting X-raysusing an X-ray detector system; (4) positioning a mounting rail throughlinear extension/retraction to: at a first time and at a first extensionposition of the mounting rail, position the scintillation detectorsystem opposite the patient position from the exit nozzle and at asecond time and at a second extension position of the mounting rail,position the X-ray detector system opposite the patient position fromthe exit nozzle; (5) generating an image of the tumor using output ofthe scintillation detector system and the X-ray detector system; and (6)alternating between the step of detecting scintillation and treating thetumor via irradiation of the tumor using the positively chargedparticles.

In combination, a tomography system is optionally used in combinationwith a charged particle cancer therapy system. The tomography systemuses tomography or tomographic imaging, which refers to imaging bysections or sectioning through the use of a penetrating wave, such as apositively charge particle from an injector and/or accelerator.Optionally and preferably, a common injector, accelerator, and beamtransport system is used for both charged particle based tomographicimaging and charged particle cancer therapy. In one case, an outputnozzle of the beam transport system is positioned with a gantry systemwhile the gantry system and/or a patient support maintains ascintillation plate of the tomography system on the opposite side of thepatient from the output nozzle.

In another example, a charged particle state determination system, of acancer therapy system or tomographic imaging system, uses one or morecoated layers in conjunction with a scintillation material,scintillation detector and/or a tomographic imaging system at time oftumor and surrounding tissue sample mapping and/or at time of tumortreatment, such as to determine an input vector of the charged particlebeam into a patient and/or an output vector of the charged particle beamfrom the patient.

In another example, the charged particle tomography apparatus is used incombination with a charged particle cancer therapy system. For example,tomographic imaging of a cancerous tumor is performed using chargedparticles generated with an injector, accelerated with an accelerator,and guided with a delivery system. The cancer therapy system uses thesame injector, accelerator, and guided delivery system in deliveringcharged particles to the cancerous tumor. For example, the tomographyapparatus and cancer therapy system use a common raster beam method andapparatus for treatment of solid cancers. More particularly, theinvention comprises a multi-axis and/or multi-field raster beam chargedparticle accelerator used in: (1) tomography and (2) cancer therapy.Optionally, the system independently controls patient translationposition, patient rotation position, two-dimensional beam trajectory,delivered radiation beam energy, delivered radiation beam intensity,beam velocity, timing of charged particle delivery, and/or distributionof radiation striking healthy tissue. The system operates in conjunctionwith a negative ion beam source, synchrotron, patient positioning,imaging, and/or targeting method and apparatus to deliver an effectiveand uniform dose of radiation to a tumor while distributing radiationstriking healthy tissue.

For clarity of presentation and without loss of generality, throughoutthis document, treatment systems and imaging systems are describedrelative to a tumor of a patient. However, more generally any sample isimaged with any of the imaging systems described herein and/or anyelement of the sample is treated with the positively charged particlebeam(s) described herein.

Charged Particle Beam Therapy

Throughout this document, a charged particle beam therapy system, suchas a proton beam, hydrogen ion beam, or carbon ion beam, is described.Herein, the charged particle beam therapy system is described using aproton beam. However, the aspects taught and described in terms of aproton beam are not intended to be limiting to that of a proton beam andare illustrative of a charged particle beam system, a positively chargedbeam system, and/or a multiply charged particle beam system, such as C⁴⁺or C⁶⁺. Any of the techniques described herein are equally applicable toany charged particle beam system.

Referring now to FIG. 1A, a charged particle beam system 100 isillustrated. The charged particle beam preferably comprises a number ofsubsystems including any of: a main controller 110; an injection system120; a synchrotron 130 that typically includes: (1) an acceleratorsystem 131 and (2) an internal or connected extraction system 134; aradio-frequency cavity system 180; a beam transport system 135; ascanning/targeting/delivery system 140; a nozzle system 146; a patientinterface module 150; a display system 160; and/or an imaging system170.

An exemplary method of use of the charged particle beam system 100 isprovided. The main controller 110 controls one or more of the subsystemsto accurately and precisely deliver protons to a tumor of a patient. Forexample, the main controller 110 obtains an image, such as a portion ofa body and/or of a tumor, from the imaging system 170. The maincontroller 110 also obtains position and/or timing information from thepatient interface module 150. The main controller 110 optionallycontrols the injection system 120 to inject a proton into a synchrotron130. The synchrotron typically contains at least an accelerator system131 and an extraction system 134. The main controller 110 preferablycontrols the proton beam within the accelerator system, such as bycontrolling speed, trajectory, and timing of the proton beam. The maincontroller then controls extraction of a proton beam from theaccelerator through the extraction system 134. For example, thecontroller controls timing, energy, and/or intensity of the extractedbeam. The controller 110 also preferably controls targeting of theproton beam through the scanning/targeting/delivery system 140 to thepatient interface module 150 or a patient with a patient positioningsystem. One or more components of the patient interface module 150, suchas translational and rotational position of the patient, are preferablycontrolled by the main controller 110. Further, display elements of thedisplay system 160 are preferably controlled via the main controller110. Displays, such as display screens, are typically provided to one ormore operators and/or to one or more patients. In one embodiment, themain controller 110 times the delivery of the proton beam from allsystems, such that protons are delivered in an optimal therapeuticmanner to the tumor of the patient.

Herein, the main controller 110 refers to a single system controllingthe charged particle beam system 100, to a single controller controllinga plurality of subsystems controlling the charged particle beam system100, or to a plurality of individual controllers controlling one or moresub-systems of the charged particle beam system 100.

Example I Charged Particle Cancer Therapy System Control

Referring now to FIG. 1B, an illustrative exemplary embodiment of oneversion of the charged particle beam system 100 is provided. The number,position, and described type of components is illustrative andnon-limiting in nature. In the illustrated embodiment, the injectionsystem 120 or ion source or charged particle beam source generatesprotons. The injection system 120 optionally includes one or more of: anegative ion beam source, a positive ion beam soure, an ion beamfocusing lens, and a tandem accelerator. The protons are delivered intoa vacuum tube that runs into, through, and out of the synchrotron. Thegenerated protons are delivered along an initial path 262. Optionally,focusing magnets 127, such as quadrupole magnets or injection quadrupolemagnets, are used to focus the proton beam path. A quadrupole magnet isa focusing magnet. An injector bending magnet 128 bends the proton beamtoward a plane of the synchrotron 130. The focused protons having aninitial energy are introduced into an injector magnet 129, which ispreferably an injection Lambertson magnet. Typically, the initial beampath 262 is along an axis off of, such as above, a circulating plane ofthe synchrotron 130. The injector bending magnet 128 and injector magnet129 combine to move the protons into the synchrotron 130. Main bendingmagnets, dipole magnets, turning magnets, or circulating magnets 132 areused to turn the protons along a circulating beam path 164. A dipolemagnet is a bending magnet. The main bending magnets 132 bend theinitial beam path 262 into a circulating beam path 164. In this example,the main bending magnets 132 or circulating magnets are represented asfour sets of four magnets to maintain the circulating beam path 164 intoa stable circulating beam path. However, any number of magnets or setsof magnets are optionally used to move the protons around a single orbitin the circulation process. The protons pass through an accelerator 133.The accelerator accelerates the protons in the circulating beam path164. As the protons are accelerated, the fields applied by the magnetsare increased. Particularly, the speed of the protons achieved by theaccelerator 133 are synchronized with magnetic fields of the mainbending magnets 132 or circulating magnets to maintain stablecirculation of the protons about a central point or region 136 of thesynchrotron. At separate points in time the accelerator 133/main bendingmagnet 132 combination is used to accelerate and/or decelerate thecirculating protons while maintaining the protons in the circulatingpath or orbit. An extraction element of an inflector/deflector system isused in combination with a Lambertson extraction magnet 137 to removeprotons from their circulating beam path 164 within the synchrotron 130.One example of a deflector component is a Lambertson magnet. Typicallythe deflector moves the protons from the circulating plane to an axisoff of the circulating plane, such as above the circulating plane.Extracted protons are preferably directed and/or focused using anextraction bending magnet 142 and optional extraction focusing magnets141, such as quadrupole magnets, and optional bending magnets along apositively charged particle beam transport path 268 in a beam transportsystem 135, such as a beam path or proton beam path, into thescanning/targeting/delivery system 140. Two components of a scanningsystem 140 or targeting system typically include a first axis control143, such as a vertical control, and a second axis control 144, such asa horizontal control. In one embodiment, the first axis control 143allows for about 100 mm of vertical or y-axis scanning of the protonbeam 268 and the second axis control 144 allows for about 700 mm ofhorizontal or x-axis scanning of the proton beam 268. A nozzle system146 is used for directing the proton beam, for imaging the proton beam,for defining shape of the proton beam, and/or as a vacuum barrierbetween the low pressure beam path of the synchrotron and theatmosphere. Protons are delivered with control to the patient interfacemodule 150 and to a tumor of a patient. All of the above listed elementsare optional and may be used in various permutations and combinations.

Ion Extraction from Ion Source

For clarity of presentation and without loss of generality, examplesfocus on protons from the ion source. However, more generally cations ofany charge are optionally extracted from a corresponding ion source withthe techniques described herein. For instance, C⁴⁺ or C⁶⁺ are optionallyextracted using the ion extraction methods and apparatus describedherein. Further, by reversing polarity of the system, anions areoptionally extracted from an anion source, where the anion is of anycharge.

Herein, for clarity of presentation and without loss of generality, ionextraction is coupled with tumor treatment and/or tumor imaging.However, the ion extraction is optional used in any method or apparatususing a stream or time discrete bunches of ions.

Beam Transport

The beam transport system 135 is used to move the charged particles fromthe accelerator to the patient, such as via a nozzle in a gantry,described infra.

Nozzle

After extraction from the synchrotron 130 and transport of the chargedparticle beam along the proton beam path 268 in the beam transportsystem 135, the charged particle beam exits through the nozzle system146. In one example, the nozzle system includes a nozzle foil coveringan end of the nozzle system 146 or a cross-sectional area within thenozzle system forming a vacuum seal. The nozzle system includes a nozzlethat expands in x/y-cross-sectional area along the z-axis of the protonbeam path 268 to allow the proton beam 268 to be scanned along thex-axis and y-axis by the vertical control element and horizontal controlelement, respectively. The nozzle foil is preferably mechanicallysupported by the outer edges of an exit port of the nozzle or nozzlesystem 146. An example of a nozzle foil is a sheet of about 0.1 inchthick aluminum foil. Generally, the nozzle foil separates atmospherepressures on the patient side of the nozzle foil from the low pressureregion, such as about 10⁻⁵ to 10⁻⁷ torr region, on the synchrotron 130side of the nozzle foil. The low pressure region is maintained to reducescattering of the circulating charged particle beam in the synchrotron.Herein, the exit foil of the nozzle is optionally the first sheet 760 ofthe charged particle beam state determination system 750, describedinfra.

Tomography/Beam State

In one embodiment, the charged particle tomography apparatus is used toimage a tumor in a patient. As current beam positiondetermination/verification is used in both tomography and cancer therapytreatment, for clarity of presentation and without limitation beam statedetermination is also addressed in this section. However, beam statedetermination is optionally used separately and without tomography.

In another example, the charged particle tomography apparatus is used incombination with a charged particle cancer therapy system using commonelements. For example, tomographic imaging of a cancerous tumor isperformed using charged particles generated with an injector,accelerator, and guided with a delivery system that are part of thecancer therapy system, described supra.

In various examples, the tomography imaging system is optionallysimultaneously operational with a charged particle cancer therapy systemusing common elements, allows tomographic imaging with rotation of thepatient, is operational on a patient in an upright, semi-upright, and/orhorizontal position, is simultaneously operational with X-ray imaging,and/or allows use of adaptive charged particle cancer therapy. Further,the common tomography and cancer therapy apparatus elements areoptionally operational in a multi-axis and/or multi-field raster beammode.

In conventional medical X-ray tomography, a sectional image through abody is made by moving one or both of an X-ray source and the X-ray filmin relative to the patient during the exposure. By modifying thedirection and extent of the movement, operators can select differentfocal planes, which contain the structures of interest. More modernvariations of tomography involve gathering projection data from multipledirections by moving the X-ray source and feeding the data into atomographic reconstruction software algorithm processed by a computer.Herein, in stark contrast to known methods, the radiation source is acharged particle, such as a proton ion beam or a carbon ion beam. Aproton beam is used herein to describe the tomography system, but thedescription applies to a heavier ion beam, such as a carbon ion beam.Further, in stark contrast to known techniques, herein the radiationsource is optionally stationary while the patient is rotated.

Referring now to FIG. 2, an example of a tomography apparatus isdescribed and an example of a beam state determination is described. Inthis example, the tomography system 200 uses elements in common with thecharged particle beam system 100, including elements of one or more ofthe injection system 120, the accelerator 130, a positively chargedparticle beam transport path 268 within a beam transport housing 261 inthe beam transport system 135, the targeting/delivery system 140, thepatient interface module 150, the display system 160, and/or the imagingsystem 170, such as the X-ray imaging system. The scintillation materialis optionally one or more scintillation plates, such as a scintillatingplastic, used to measure energy, intensity, and/or position of thecharged particle beam. For instance, a scintillation material 210 orscintillation plate is positioned behind the patient 230 relative to thetargeting/delivery system 140 elements, which is optionally used tomeasure intensity and/or position of the charged particle beam aftertransmitting through the patient. Optionally, a second scintillationplate or a charged particle induced photon emitting sheet, describedinfra, is positioned prior to the patient 230 relative to thetargeting/delivery system 140 elements, which is optionally used tomeasure incident intensity and/or position of the charged particle beamprior to transmitting through the patient. The charged particle beamsystem 100 as described has proven operation at up to and including 330MeV, which is sufficient to send protons through the body and intocontact with the scintillation material. Particularly, 250 MeV to 330MeV are used to pass the beam through a standard sized patient with astandard sized pathlength, such as through the chest. The intensity orcount of protons hitting the plate as a function of position is used tocreate an image. The velocity or energy of the proton hitting thescintillation plate is also used in creation of an image of the tumor220 and/or an image of the patient 230. The patient 230 is rotated aboutthe y-axis and a new image is collected. Preferably, a new image iscollected with about every one degree of rotation of the patientresulting in about 360 images that are combined into a tomogram usingtomographic reconstruction software. The tomographic reconstructionsoftware uses overlapping rotationally varied images in thereconstruction. Optionally, a new image is collected at about every 2,3, 4, 5, 10, 15, 30, or 45 degrees of rotation of the patient.

Herein, the scintillation material 210 or scintillator is any materialthat emits a photon when struck by a positively charged particle or whena positively charged particle transfers energy to the scintillationmaterial sufficient to cause emission of light. Optionally, thescintillation material 210 emits the photon after a delay, such as influorescence or phosphorescence. However, preferably, the scintillatorhas a fast fifty percent quench time, such as less than 0.0001, 0.001,0.01, 0.1, 1, 10, 100, or 1,000 milliseconds, so that the light emissiongoes dark, falls off, or terminates quickly. Preferred scintillationmaterials include sodium iodide, potassium iodide, cesium iodide, aniodide salt, and/or a doped iodide salt. Additional examples of thescintillation materials include, but are not limited to: an organiccrystal, a plastic, a glass, an organic liquid, a luminophor, and/or aninorganic material or inorganic crystal, such as barium fluoride, BaF₂;calcium fluoride, CaF₂, doped calcium fluoride, sodium iodide, NaI;doped sodium iodide, sodium iodide doped with thallium, NaI(Tl); cadmiumtungstate, CdWO₄; bismuth germanate; cadmium tungstate, CdWO₄; calciumtungstate, CaWO₄; cesium iodide, CsI; doped cesium iodide; cesium iodidedoped with thallium, CsI(Tl); cesium iodide doped with sodium CsI(Na);potassium iodide, KI; doped potassium iodide, gadolinium oxysulfide,Gd₂O₂S; lanthanum bromide doped with cerium, LaBr₃(Ce); lanthanumchloride, LaCl₃; cesium doped lanthanum chloride, LaCl₃(Ce); leadtungstate, PbWO₄; LSO or lutetium oxyorthosilicate (Lu₂SiO₅); LYSO,Lu_(1.8)Y_(0.2)SiO₅(Ce); yttrium aluminum garnet, YAG(Ce); zinc sulfide,ZnS(Ag); and zinc tungstate, ZnWO₄.

In one embodiment, a tomogram or an individual tomogram section image iscollected at about the same time as cancer therapy occurs using thecharged particle beam system 100. For example, a tomogram is collectedand cancer therapy is subsequently performed: without the patient movingfrom the positioning systems, such as in a semi-vertical partialimmobilization system, a sitting partial immobilization system, or the alaying position. In a second example, an individual tomogram slice iscollected using a first cycle of the accelerator 130 and using afollowing cycle of the accelerator 130, the tumor 220 is irradiated,such as within about 1, 2, 5, 10, 15 or 30 seconds. In a third case,about 2, 3, 4, or 5 tomogram slices are collected using 1, 2, 3, 4, ormore rotation positions of the patient 230 within about 5, 10, 15, 30,or 60 seconds of subsequent tumor irradiation therapy.

In another embodiment, the independent control of the tomographicimaging process and X-ray collection process allows simultaneous singleand/or multi-field collection of X-ray images and tomographic imageseasing interpretation of multiple images. Indeed, the X-ray andtomographic images are optionally overlaid and/or integrated to from ahybrid X-ray/proton beam tomographic image as the patient 230 isoptionally in the same position for each image.

In still another embodiment, the tomogram is collected with the patient230 in the about the same position as when the patient's tumor istreated using subsequent irradiation therapy. For some tumors, thepatient being positioned in the same upright or semi-upright positionallows the tumor 220 to be separated from surrounding organs or tissueof the patient 230 better than in a laying position. Positioning of thescintillation material 210 behind the patient 230 allows the tomographicimaging to occur while the patient is in the same upright orsemi-upright position.

The use of common elements in the tomographic imaging and in the chargedparticle cancer therapy allows benefits of the cancer therapy, describedsupra, to optionally be used with the tomographic imaging, such asproton beam x-axis control, proton beam y-axis control, control ofproton beam energy, control of proton beam intensity, timing control ofbeam delivery to the patient, rotation control of the patient, andcontrol of patient translation all in a raster beam mode of protonenergy delivery. The use of a single proton or cation beamline for bothimaging and treatment eases patient setup, reduces alignmentuncertainties, reduces beam state uncertainties, and eases qualityassurance.

In yet still another embodiment, initially a three-dimensionaltomographic X-ray and/or proton based reference image is collected, suchas with hundreds of individual rotation images of the tumor 220 andpatient 230. Subsequently, just prior to proton treatment of the cancer,just a few 2-dimensional control tomographic images of the patient arecollected, such as with a stationary patient or at just a few rotationpositions, such as an image straight on to the patient, with the patientrotated about 45 degrees each way, and/or the X-ray source and/orpatient rotated about 90 degrees each way about the y-axis. Theindividual control images are compared with the 3-dimensional referenceimage. An adaptive proton therapy is optionally subsequently performedwhere: (1) the proton cancer therapy is not used for a given positionbased on the differences between the 3-dimensional reference image andone or more of the 2-dimensional control images and/or (2) the protoncancer therapy is modified in real time based on the differences betweenthe 3-dimensional reference image and one or more of the 2-dimensionalcontrol images.

Charged Particle State Determination/Verification/Photonic Monitoring

Still referring to FIG. 2, the tomography system 200 is optionally usedwith a charged particle beam state determination system 250, optionallyused as a charged particle verification system. The charged particlestate determination system 250 optionally measures, determines, and/orverifies one of more of: (1) position of the charged particle beam, suchas a treatment beam 269, (2) direction of the treatment beam 269, (3)intensity of the treatment beam 269, (4) energy of the treatment beam269, (5) position, direction, intensity, and/or energy of the chargedparticle beam, such as a residual charged particle beam 267 afterpassing through a sample or the patient 230, and/or (6) a history of thecharged particle beam.

For clarity of presentation and without loss of generality, adescription of the charged particle beam state determination system 250is described and illustrated separately in FIG. 3 and FIG. 4A; however,as described herein elements of the charged particle beam statedetermination system 250 are optionally and preferably integrated intothe nozzle system 146 and/or the tomography system 200 of the chargedparticle treatment system 100. More particularly, any element of thecharged particle beam state determination system 250 is integrated intothe nozzle system 146, a dynamic gantry nozzle, and/or tomography system200, such as a surface of the scintillation material 210 or a surface ofa scintillation detector, plate, or system. The nozzle system 146 or thedynamic gantry nozzle provides an outlet of the charged particle beamfrom the vacuum tube initiating at the injection system 120 and passingthrough the synchrotron 130 and beam transport system 135. Any plate,sheet, fluorophore, or detector of the charged particle beam statedetermination system is optionally integrated into the nozzle system146. For example, an exit foil of the nozzle is optionally a first sheet252 of the charged particle beam state determination system 250 and afirst coating 254 is optionally coated onto the exit foil, asillustrated in FIG. 2. Similarly, optionally a surface of thescintillation material 210 is a support surface for a fourth coating292, as illustrated in FIG. 2. The charged particle beam statedetermination system 250 is further described, infra.

Referring now to FIG. 2, FIG. 3, and FIG. 4A, four sheets, a first sheet252, a second sheet 270, a third sheet 280, and a fourth sheet 290 areused to illustrate detection sheets and/or photon emitting sheets upontransmittance of a charged particle beam. Each sheet is optionallycoated with a photon emitter, such as a fluorophore, such as the firstsheet 252 is optionally coated with a first coating 254. Without loss ofgenerality and for clarity of presentation, the four sheets are eachillustrated as units, where the light emitting layer is not illustrated.Thus, for example, the second sheet 270 optionally refers to a supportsheet, a light emitting sheet, and/or a support sheet coated by a lightemitting element. The four sheets are representative of n sheets, wheren is a positive integer.

Referring now to FIG. 2 and FIG. 3, the charged particle beam stateverification system 250 is a system that allows for monitoring of theactual charged particle beam position in real-time without destructionof the charged particle beam. The charged particle beam stateverification system 250 preferably includes a first position element orfirst beam verification layer, which is also referred to herein as acoating, luminescent, fluorescent, phosphorescent, radiance, or viewinglayer. The first position element optionally and preferably includes acoating or thin layer substantially in contact with a sheet, such as aninside surface of the nozzle foil, where the inside surface is on thesynchrotron side of the nozzle foil. Less preferably, the verificationlayer or coating layer is substantially in contact with an outer surfaceof the nozzle foil, where the outer surface is on the patient treatmentside of the nozzle foil. Preferably, the nozzle foil provides asubstrate surface for coating by the coating layer. Optionally, abinding layer is located between the coating layer and the nozzle foil,substrate, or support sheet. Optionally, the position element is placedanywhere in the charged particle beam path. Optionally, more than oneposition element on more than one sheet, respectively, is used in thecharged particle beam path and is used to determine a state property ofthe charged particle beam, as described infra.

Still referring to FIG. 2 and FIG. 3, the coating, referred to as afluorophore, yields a measurable spectroscopic response, spatiallyviewable by a detector or camera, as a result of transmission by theproton beam. The coating is preferably a phosphor, but is optionally anymaterial that is viewable or imaged by a detector where the materialchanges, as viewed spectroscopically, as a result of the chargedparticle beam hitting or transmitting through the coating or coatinglayer. A detector or camera views secondary photons emitted from thecoating layer and determines a position of a treatment beam 269, whichis also referred to as a current position of the charged particle beamor final treatment vector of the charged particle beam, by thespectroscopic differences resulting from protons and/or charged particlebeam passing through the coating layer. For example, the camera views asurface of the coating surface as the proton beam or positively chargedcation beam is being scanned by the first axis control 143, verticalcontrol, and the second axis control 144, horizontal control, beamposition control elements during treatment of the tumor 220. The cameraviews the current position of the charged particle beam or treatmentbeam 269 as measured by spectroscopic response. The coating layer ispreferably a phosphor or luminescent material that glows and/or emitsphotons for a short period of time, such as less than 5 seconds for a50% intensity, as a result of excitation by the charged particle beam.The detector observes the temperature change and/or observe photonsemitted from the charged particle beam traversed spot. Optionally, aplurality of cameras or detectors are used, where each detector viewsall or a portion of the coating layer. For example, two detectors areused where a first detector views a first half of the coating layer andthe second detector views a second half of the coating layer.Preferably, at least a portion of the detector is mounted into thenozzle system to view the proton beam position after passing through thefirst axis and second axis controllers 143, 144. Preferably, the coatinglayer is positioned in the proton beam path 268 in a position prior tothe protons striking the patient 230.

Referring now to FIG. 1 and FIG. 2, the main controller 110, connectedto the camera or detector output, optionally and preferably compares thefinal proton beam position or position of the treatment beam 269 withthe planned proton beam position and/or a calibration reference, such asa calibrated beamline, to determine if the actual proton beam positionor position of the treatment beam 269 is within tolerance. The chargedparticle beam state determination system 250 preferably is used in oneor more phases, such as a calibration phase, a mapping phase, a beamposition verification phase, a treatment phase, and a treatment planmodification phase. The calibration phase is used to correlate, as afunction of x-, y-position of the first axis control 143 and the secondaxis control 144 response the actual x-, y-position of the proton beamat the patient interface. During the treatment phase, the chargedparticle beam position is monitored and compared to the calibrationand/or treatment plan to verify accurate proton delivery to the tumor220 and/or as a charged particle beam shutoff safety indicator.Referring now to FIG. 5, the position verification system 179 and/or atreatment delivery control system 112, upon determination of a tumorshift, an unpredicted tumor distortion upon treatment, and/or atreatment anomaly optionally generates and or provides a recommendedtreatment change 1070. The treatment change 1070 is optionally sent outwhile the patient 230 is still in the treatment position, such as to aproximate physician or over the internet to a remote physician, forphysician approval 1072, receipt of which allows continuation of the nowmodified and approved treatment plan.

Example I

Referring now to FIG. 2, a first example of the charged particle beamstate determination system 250 is illustrated using two cation inducedsignal generation surfaces, referred to herein as the first sheet 252and a third sheet 780. Each sheet is described below.

Still referring to FIG. 2, in the first example, the optional firstsheet 252, located in the charged particle beam path prior to thepatient 230, is coated with a first fluorophore coating 254, wherein acation, such as in the charged particle beam, transmitting through thefirst sheet 252 excites localized fluorophores of the first fluorophorecoating 254 with resultant emission of one or more photons. In thisexample, a first detector 212 images the first fluorophore coating 254and the main controller 110 determines a current position of the chargedparticle beam using the image of the fluorophore coating 254 and thedetected photon(s). The intensity of the detected photons emitted fromthe first fluorophore coating 254 is optionally used to determine theintensity of the charged particle beam used in treatment of the tumor220 or detected by the tomography system 200 in generation of a tomogramand/or tomographic image of the tumor 220 of the patient 230. Thus, afirst position and/or a first intensity of the charged particle beam isdetermined using the position and/or intensity of the emitted photons,respectively.

Still referring to FIG. 2, in the first example, the optional thirdsheet 280, positioned posterior to the patient 230, is optionally acation induced photon emitting sheet as described in the previousparagraph. However, as illustrated, the third sheet 280 is a solid statebeam detection surface, such as a detector array. For instance, thedetector array is optionally a charge coupled device, a charge induceddevice, CMOS, or camera detector where elements of the detector arrayare read directly, as does a commercial camera, without the secondaryemission of photons. Similar to the detection described for the firstsheet, the third sheet 280 is used to determine a position of thecharged particle beam and/or an intensity of the charged particle beamusing signal position and/or signal intensity from the detector array,respectively.

Still referring to FIG. 2, in the first example, signals from the firstsheet 252 and third sheet 280 yield a position before and after thepatient 230 allowing a more accurate determination of the chargedparticle beam through the patient 230 therebetween. Optionally,knowledge of the charged particle beam path in the targeting/deliverysystem 140, such as determined via a first magnetic field strengthacross the first axis control 143 or a second magnetic field strengthacross the second axis control 144 is combined with signal derived fromthe first sheet 252 to yield a first vector of the charged particlesprior to entering the patient 230 and/or an input point of the chargedparticle beam into the patient 230, which also aids in: (1) controlling,monitoring, and/or recording tumor treatment and/or (2) tomographydevelopment/interpretation. Optionally, signal derived from use of thethird sheet 280, posterior to the patient 230, is combined with signalderived from tomography system 200, such as the scintillation material210, to yield a second vector of the charged particles posterior to thepatient 230 and/or an output point of the charged particle beam from thepatient 230, which also aids in: (1) controlling, monitoring,deciphering, and/or (2) interpreting a tomogram or a tomographic image.

For clarity of presentation and without loss of generality, detection ofphotons emitted from sheets is used to further describe the chargedparticle beam state determination system 250. However, any of the cationinduced photon emission sheets described herein are alternativelydetector arrays. Further, any number of cation induced photon emissionsheets are used prior to the patient 730 and/or posterior to the patient230, such a 1, 2, 3, 4, 6, 8, 10, or more. Still further, any of thecation induced photon emission sheets are place anywhere in the chargedparticle beam, such as in the synchrotron 130, in the beam transportsystem 135, in the targeting/delivery system 140, the nozzle system 146,in the treatment room, and/or in the tomography system 200. Any of thecation induced photon emission sheets are used in generation of a beamstate signal as a function of time, which is optionally recorded, suchas for an accurate history of treatment of the tumor 220 of the patient230 and/or for aiding generation of a tomographic image.

Example II

Referring now to FIG. 3, a second example of the charged particle beamstate determination system 250 is illustrated using three cation inducedsignal generation surfaces, referred to herein as the second sheet 270,the third sheet 280, and the fourth sheet 290. Any of the second sheet270, the third sheet 280, and the fourth sheet 290 contain any of thefeatures of the sheets described supra.

Still referring to FIG. 3, in the second example, the second sheet 270,positioned prior to the patient 230, is optionally integrated into thenozzle and/or the nozzle system 146, but is illustrated as a separatesheet. Signal derived from the second sheet 270, such as at point A, isoptionally combined with signal from the first sheet 252 and/or state ofthe targeting/delivery system 140 to yield a first line or vector,v_(1a), from point A to point B of the charged particle beam prior tothe sample or patient 230 at a first time, t₁, and a second line orvector, v_(2a), from point F to point G of the charged particle beamprior to the sample at a second time, t₂.

Still referring to FIG. 3, in the second example, the third sheet 280and the fourth sheet 290, positioned posterior to the patient 230, areoptionally integrated into the tomography system 200, but areillustrated as a separate sheets. Signal derived from the third sheet280, such as at point D, is optionally combined with signal from thefourth sheet 290 and/or signal from the tomography system 200 to yield afirst line segment or vector, v_(1b), from point C₂ to point D and/orfrom point D to point E of the charged particle beam posterior to thepatient 230 at the first time, t₁, and a second line segment or vector,v_(2b), such as from point H to point I of the charged particle beamposterior to the sample at a second time, t₂. Signal derived from thethird sheet 280 and/or from the fourth sheet 290 and the correspondingfirst vector at the second time, t₂, is used to determine an outputpoint, C₂, which may and often does differ from an extension of thefirst vector, V_(1a), from point A to point B through the patient to anon-scattered beam path of point C₁. The difference between point C₁ andpoint C₂ and/or an angle, α, between the first vector at the first time,v_(1a), and the first vector at the second time, v_(1b), is used todetermine/map/identify, such as via tomographic analysis, internalstructure of the patient 230, sample, and/or the tumor 220, especiallywhen combined with scanning the charged particle beam in the x/y-planeas a function of time, such as illustrated by the second vector at thefirst time, v_(2a), and the second vector at the second time, v_(2b),forming angle 13 and/or with rotation of the patient 230, such as aboutthe y-axis, as a function of time.

Still referring to FIG. 3, multiple detectors/detector arrays areillustrated for detection of signals from multiple sheets, respectively.However, a single detector/detector array is optionally used to detectsignals from multiple sheets, as further described infra. Asillustrated, a set of detectors 211 is illustrated, including a seconddetector 214 imaging the second sheet 270, a third detector 216 imagingthe third sheet 280, and a fourth detector 218 imaging the fourth sheet290. Any of the detectors described herein are optionally detectorarrays, are optionally coupled with any optical filter, and/oroptionally use one or more intervening optics to image any of the foursheets 252, 270, 280, 290. Further, two or more detectors optionallyimage a single sheet, such as a region of the sheet, to aid opticalcoupling, such as F-number optical coupling.

Still referring to FIG. 3, a vector or line segment of the chargedparticle beam is determined. Particularly, in the illustrated example,the third detector 216, determines, via detection of secondary emittedphotons, that the charged particle beam transmitted through point D andthe fourth detector 218 determines that the charged particle beamtransmitted through point E, where points D and E are used to determinethe first vector or line segment at the second time, v_(1b), asdescribed supra. To increase accuracy and precision of a determinedvector of the charged particle beam, a first determined beam positionand a second determined beam position are optionally and preferablyseparated by a distance, d₁, such as greater than 0.1, 0.5, 1, 2, 3, 5,10, or more centimeters. A support element 252 is illustrated thatoptionally connects any two or more elements of the charged particlebeam state determination system 250 to each other and/or to any elementof the charged particle beam system 100, such as a rotating platform 256used to position and/or co-rotate the patient 230 and any element of thetomography system 200.

Example III

Still referring to FIG. 4A, a third example of the charged particle beamstate determination system 250 is illustrated in an integratedtomography-cancer therapy system 400.

Referring to FIG. 4A, multiple sheets and multiple detectors areillustrated determining a charged particle beam state prior to thepatient 230. As illustrated, a first camera 212 spatially images photonsemitted from the first sheet 260 at point A, resultant from energytransfer from the passing charged particle beam, to yield a first signaland a second camera 214 spatially images photons emitted from the secondsheet 270 at point B, resultant from energy transfer from the passingcharged particle beam, to yield a second signal. The first and secondsignals allow calculation of the first vector or line segment, v_(1a),with a subsequent determination of an entry point 232 of the chargedparticle beam into the patient 230. Determination of the first vector,v_(1a), is optionally supplemented with information derived from statesof the magnetic fields about the first axis control 143, the verticalcontrol, and the second axis control 144, the horizontal axis control,as described supra.

Still referring to FIG. 4A, the charged particle beam statedetermination system is illustrated with multiple resolvable wavelengthsof light emitted as a result of the charged particle beam transmittingthrough more than one molecule type, light emission center, and/orfluorophore type. For clarity of presentation and without loss ofgenerality a first fluorophore in the third sheet 280 is illustrated asemitting blue light, b, and a second fluorophore in the fourth sheet 290is illustrated as emitting red light, r, that are both detected by thethird detector 216. The third detector is optionally coupled with anywavelength separation device, such as an optical filter, grating, orFourier transform device. For clarity of presentation, the system isdescribed with the red light passing through a red transmission filterblocking blue light and the blue light passing through a bluetransmission filter blocking red light. Wavelength separation, using anymeans, allows one detector to detect a position of the charged particlebeam resultant in a first secondary emission at a first wavelength, suchas at point C, and a second secondary emission at a second wavelength,such as at point D. By extension, with appropriate optics, one camera isoptionally used to image multiple sheets and/or sheets both prior to andposterior to the sample. Spatial determination of origin of the redlight and the blue light allow calculation of the first vector at thesecond time, V_(1b), and an actual exit point 236 from the patient 230as compared to a non-scattered exit point 234 from the patient 230 asdetermined from the first vector at the first time, V_(1a).

Ion Beam State Determination/Energy Dissipation System

Referring now to FIG. 4B-4H an ion beam state determination/kineticenergy dissipation system is described. Generally, a dual use chamber isdescribed functioning at a first time, when filled with gas, as anelement in an ion beam state determination system and functioning at asecond time, when filled with liquid, as an element of a kinetic energydissipation system. The dual purpose/use chamber is further describedherein.

Ionization Strip Detector

Referring now to FIGS. 4(A-C), an ion beam location determination systemis described. In FIG. 4A, x/y-beam positions are determined using afirst sheet 260 and a second sheet 270, such as where the sheets emitphotons. In FIG. 4B, the first sheet 260 comprises a first axis, orx-axis, ionization strip detector 410. In the first ionization stripdetector 410, an x-axis position of the positive ion beam is determinedusing vertical strips, where interaction of the positive ion with one ormore vertical strips of the x-axis interacting strips 411 results inelectron emission, the current carried by the interacting strip andconverted to an x-axis position signal, such as with an x-axis register412, detector, integrator, and/or amplifier. Similarly, in the secondionization strip detector 415, a y-axis position of the positive ionbeam is determined using horizontal strips, where interaction of thepositive ion results with one or more horizontal strips of the y-axisionization strips 416 results in another electron emission, theresulting current carried by the y-axis interacting strip and convertedto a y-axis position signal, such as with a y-axis register 417,detector, integrator, and/or amplifier.

Dual Use Ion Chamber

Referring now to FIG. 4D a dual use ionization chamber 420 isillustrated. The dual use ionization chamber 420 is optionallypositioned anywhere in an ion beam path, in a negatively chargedparticle beam path, and/or in a positively charged particle beam path,where the positively charged particle beam path is used herein forclarity of presentation. Herein, for clarity of presentation and withoutloss of generality, the dual use ionization chamber 420 is integratedinto and/or is adjacent the nozzle system 146. The dual use ionizationchamber 420 comprises any material, but is optionally and preferably aplastic, polymer, polycarbonate, and/or an acrylic. The dual useionization chamber 420 comprises: a charged particle beam entrance side423 and a charged particle beam exit side 425. The positively chargedparticle beam path optionally and preferably passes through an entranceaperture 424 in the beam entrance side of the dual use ionizationchamber 420 and exits the dual use ionization chamber 420 through anexit aperture 426 in the charged particle beam exit side 425. Theentrance aperture 424 and/or the exit aperture 426 are optionallycovered with a liquid tight and/or gas tight optic or film, such as awindow, glass, optical cell surface, film, membrane, a polyimide film,an aluminum coated film, and/or an aluminum coated polyimide film.

Example I

In a first example, referring now to FIG. 4D and FIG. 4E, the entranceaperture 424 and exit aperture 426 of the charged particle beam entranceside 423 and the charged particle beam exit side 425, respectively, ofthe dual use ionization chamber 420 are further described. Moreparticularly, the first ionization strip detector 410 and the secondionization strip detector 415 are coupled with the dual use ionizationchamber 420. As illustrated, the first ionization strip detector 410 andthe second ionization strip detector 415 cover the entrance aperture 424and optionally and preferably form a liquid and/or gas tight seal to theentrance side 423 of the dual use ionization chamber 420.

Example II

In a second example, referring still to FIG. 4D and FIG. 4E, theentrance aperture 424 and exit aperture 426 of the charged particle beamentrance side 423 and the charged particle beam exit side 425,respectively, of the dual use ionization chamber 420 are furtherdescribed. More particularly, in this example, the first ionizationstrip detector 410 and the second ionization strip detector 415 areintegrated into the exit aperture 426 of the use ionization chamber 420.As illustrated, an aluminum coated film 421 is also integrated into theexit aperture 426.

Example III

In a third example, referring still to FIG. 4D and FIG. 4E, the firstionization detector 410 and the second ionization detector 415 areoptionally used to: (1) cover and/or function as an element of a seal ofthe entrance aperture 424 and/or the exit aperture 426 and/or (2)function to determine a position and/or state of the positively chargedion beam at and/or near one or both of the entrance aperture 424 and theexit aperture 426 of the dual use ionization chamber 420.

Referring now to FIG. 4F, two uses of the dual use ionization chamber420 are described. At a first time, the dual use ionization chamber 420is filled, at least to above a path of the charged particle beam, with aliquid. The liquid is used to reduce and/or dissipate the kinetic energyof the positively charged particle beam. At a second time, the dual useionization chamber 420 is filled, at least in a volume of the chargedparticle beam, with a gas. The gas, such as helium, functions tomaintain the charged particle beam integrity, focus, state, and/ordimensions as the helium scatters the positively charged particle beamless than air, where the pathlength of the dual use ionization chamber420 is necessary to separate elements of the nozzle system, such as thefirst axis control 143, the second axis control 144, the first sheet260, the second sheet 270, the third sheet 280, the fourth sheet 290,and/or one or more instances of the first ionization detector 410 andthe second ionization detector 415.

Kinetic Energy Dissipater

Referring still to FIG. 4F, the kinetic energy dissipation aspect of thedual use ionization chamber 420 is further described. At a first time, aliquid, such as water is moved, such as with a pump, into the dual useionization chamber 420. The water interacts with the proton beam to slowand/or stop the proton beam. At a second time, the liquid is removed,such as with a pump and/or drain, from the dual use ionization chamber420. Through use of more water than will fit into the dual useionization chamber 420, the radiation level of the irradiated water perunit volume is decreased. The decreased radiation level allows morerapid access to the ionization chamber, which is very useful formaintenance and even routine use of a high power proton beam cancertherapy system. The inventor notes that immediate access to the chamberis allowed versus a standard and mandatory five hour delay to allowradiation dissipation using a traditional solid phase proton beam energyreducer.

Example I

Still referring to FIG. 4F, an example of use of a liquidmovement/exchange system 430 is provided, where the liquid exchangesystem 430 is used to dissipate kinetic energy and/or to disperseradiation. Generally, the liquid exchange system moves water from theuse purpose ionization chamber 420, having a first volume 427, using oneor more water lines 436, to a liquid reservoir tank 432 having a secondvolume 434. Generally, any radiation build-up in the first volume 427 isdiluted by circulating water through the water lines 436 to the secondvolume 434, where the second volume is at least 0.25, 0.5, 1, 2, 3, 5,or 10 times the size of the first volume. As illustrated, more than onedrain line is attached to the dual use ionization chamber 420, whichallows the dual use ionization chamber 420 to drain regardless oforientation of the nozzle system 146 as the dual use ionization chamber420 optionally and preferably co-moves with the nozzle system 146 and/oris integrated into the nozzle system 146. Optionally, the liquidmovement/exchange system 430 is used to remove radiation from thetreatment room 922, to reduce radiation levels of discharged fluids toacceptable levels via dilution, and/or to move the temporarilyradioactive fluid to another area or room for later reuse in the liquidmovement/exchange system 430.

Example II

Still referring to FIG. 4F, an example of a gas movement/exchange system440 is provided, where the gas exchange system 440 is used to fill/emptygas, such as helium, from the dual use ionization chamber 420. Asillustrated, helium, from a pressurized helium tank 442 and/or a heliumdisplacement chamber 444, is moved, such as via a regulator 446 or pumpand/or via displacement by water, to/from the dual use ionizationchamber 420 using one or more gas lines. For instance, as water ispumped into the dual use ionization chamber 420 from the liquidreservoir tank 432, the water displaces the helium forcing the heliumback into the helium displacement chamber 444. Alternatingly, the heliumis moved back into the dual use ionization chamber 420 by draining thewater, as described supra, and/or by increasing the helium pressure,such as through use of the pressurized helium tank 442. A desiccator isoptionally used in the system.

It should be appreciated that the gas/liquid reservoirs, movement lines,connections, and pumps are illustrative in nature of any liquid movementsystem and/or any gas movement system. Further, the water, used in theexamples for clarity of presentation, is more generally any liquid,combination of liquids, hydrocarbon, mercury, and/or liquid bromide.Similarly, the helium, used in the examples for clarity of presentation,is more generally any gas, mixture of gases, neon, and/or nitrogen.

Generally, the liquid in the liquid exchange system 430, replacesgraphite, copper, or metal used as a kinetic energy reducer in thecancer therapy system 100. Still more generally, the liquid exchangesystem 420 is optionally used with any positive particle beam type, anynegative particle beam type, and/or with any accelerator type, such as acyclotron or a synchrotron, to reduce kinetic energy of the ion beamwhile diluting and/or removing radiation from the system.

Beam Energy Reduction

Still referring to FIG. 4F and referring now to FIG. 4H, the kineticenergy dissipation aspect of the dual use ionization chamber 420 isfurther described. A pathlength, b, between the entrance aperture 424and exit aperture 426, of 55 cm through water is sufficient to block a330 MeV proton beam, where a 330 MeV proton beam is sufficient forproton transmission tomography through a patient. Thus, smallerpathlengths are optionally used to reduce the energy of the proton beam.

Still referring to FIG. 4F, in a first optional embodiment, a series ofliquid cells of differing pathlengths are optionally moved into and outof the proton beam to reduce energy of the proton beam and thus controla depth of penetration into the patient 230. For example, anycombination of liquid cells, such as the dual use ionization chamber420, having pathlengths of 1, 2, 4, 8, 16, or 32 cm or any pathlengthfrom 0.1 to 100 cm are optionally used. Once an energy degradationpathlength is set to establish a main distance into the patient 230,energy controllers of the proton beam are optionally used to scanvarying depths into the tumor.

Still referring to FIG. 4F and referring again to FIG. 4H, in a second,preferred, optional embodiment, one or more pathlength adjustable liquidcells, such as the dual use ionization chamber 420, are positioned inthe proton beam path to use the proton beam energy to a preferred energyto target a depth of penetration into the patient 230. Two examples areused to further describe the pathlength adjustable liquid cells yieldinga continuous variation of proton beam energy.

Example I

A first example of a continuously variable proton beam energy controller470 is illustrated in FIG. 4H. It should be appreciated that a firsttriangular cross-section is used to represent the dual use ionizationchamber 420 for clarity of presentation and without loss of generality.More generally, any cross-section, continuous and/or discontinuous as afunction of x/y-axis position, is optionally used. Here, a continuousfunction, pathlength variable with x- and/or y-axis movement firstliquid cell 428 comprises a triangular cross-section. As illustrated, ata first time, t₁, the proton beam path 268 has a first pathlength, b₁,through the first liquid cell 428. At a second time, after translationof the first liquid cell 428 upward along the y-axis, the proton beampath has a second pathlength, b₂, through the first liquid cell 428.Thus, by moving the first liquid cell 428, having a non-uniformthickness, the proton beam path 268 passes through differing amounts ofliquid, yielding a range of kinetic energy dissipation. Simply, a longerpathlength, such as the second pathlength, b₂, being longer than thefirst pathlength, b₁, results in a greater slowing of the chargedparticles in the proton beam path. Herein, an initial pathlength of unitlength one is replaced with the second pathlength that is plus-or-minusat least 1, 2, 3, 4, 5, 10, 20, 30, 50, 100, or 200 percent of the firstpathlength.

Example II

A second example of a continuously variable proton beam energycontroller 470 is illustrated in FIG. 4H. As illustrated, by increasingor decreasing the first pathlength, b₁, the resultant proton beam path268 is possibly offset downward or upward respectively. To correct theproton beam path 268 back to an original vector, such as the treatmentbeam path 269, a second liquid cell 429 is used. As illustrated: (1) athird pathlength, b₃, through the second liquid cell 429 is equal to thefirst pathlength, b₁, at the first time, t₁; (2) the sign of theentrance angle of the proton beam path 268 is reversed when entering thesecond liquid cell 429 compared to entering the first liquid cell 428;and (3) the sign of the exit angle of the proton beam 268 exiting thesecond liquid cell 429 is opposite the first liquid cell 428. Further,as the first liquid cell 428 is moved in a first direction, such asupward along the y-axis as illustrated, to maintain a fourth pathlength,b₄, in the second liquid cell 429 matching the second pathlength, b₂,through the first liquid cell 428 at a second time, t₂, the secondliquid cell 429 is moved in an opposite direction, such as downwardalong the y-axis. More generally, the second liquid cell 429 optionally:(1) comprises a shape of the first liquid cell 428; (2) is rotatedone-hundred eighty degrees relative to the first liquid cell 428; and(3) is translated in an opposite direction of translation of the firstliquid cell 428 through the proton beam path 268 as a function of time.Generally, 1, 2, 3, 4, 5, or more liquid cells of any combination ofshapes are used to slow the proton beam to a desired energy and directthe resultant proton beam, such as the treatment beam 269 along a chosenvector as a function of time.

Example III

Still referring to FIG. 4F and FIG. 4H, the proton beam, is optionallyaccelerated to an energy level/speed and, using the variable pathlengthdual use ionization chamber 420, the first liquid cell 428, and/or thesecond liquid cell 429, the energy of the extracted beam is reduced tovarying magnitudes, which is a form of scanning the tumor 220, as afunction of time. This allows the synchrotron 130 to accelerate theprotons to one energy and after extraction control the energy of theproton beam, which allows a more efficient use of the synchrotron 130 asincreasing or decreasing the energy with the synchrotron 130 typicallyresults in a beam dump and recharge and/or requires significant timeand/or energy, which slows treatment of the cancer while increasing costof the cancer.

Beam State Determination

Referring now to FIG. 4G, a beam state determination system 460 isdescribed that uses one or more of the first liquid cell 428, the secondliquid cell 429, and/or the dual use ionization chamber 420. For clarityof presentation and without loss of generality, as illustrated, thefirst liquid cell 428 comprises an orthotope shape. The beam statedetermination system 460 comprises at least a beam sensing element 461responsive to the proton beam connected to the main controller 110.Optionally and preferably, the beam sensing element 461 is positionedinto various x,y,z-positions inside the liquid containing orthotope as afunction of time, which allows a mapping of properties of the protonbeam, such as: intensity, depth of penetration, energy, radialdistribution about an incident vector of the proton beam, and/or aresultant mean angle. As illustrated, the beam sensing element 461 ispositioned in the proton beam path at a first time, t₁, using athree-dimensional probe positioner, comprising: a telescoping z-axissensor positioner 462, a y-axis positioning rail 464, and an x-axispositioning rail and is positioned out of the proton beam path at asecond time, t₂ using the three-dimensional probe positioner. Generally,the probe positioner is any system capable of positioning the beamsensing element 461 as a function of time.

Still again to FIG. 4A and referring now to FIG. 4I, the integratedtomography-cancer therapy system 400 is illustrated with an optionalconfiguration of elements of the charged particle beam statedetermination system 250 being co-rotatable with the nozzle system 146of the cancer therapy system 100. More particularly, in one case sheetsof the charged particle beam state determination system 250 positionedprior to, posterior to, or on both sides of the patient 230 co-rotatewith the scintillation material 210 about any axis, such as illustratedwith rotation about the y-axis. Further, any element of the chargedparticle beam state determination system 250, such as a detector,two-dimensional detector, multiple two-dimensional detectors, and/orlight coupling optic move as the gantry moves, such as along a commonarc of movement of the nozzle system 146 and/or at a fixed distance tothe common arc. For instance, as the gantry moves, a monitoring camerapositioned on the opposite side of the tumor 220 or patient 230 from thenozzle system 146 maintains a position on the opposite side of the tumor220 or patient 230. In various cases, co-rotation is achieved byco-rotation of the gantry of the charged particle beam system and asupport of the patient, such as the rotatable platform 253, which isalso referred to herein as a movable or dynamically positionable patientplatform, patient chair, or patient couch. Mechanical elements, such asthe support element 251 affix the various elements of the chargedparticle beam state determination system 250 relative to each other,relative to the nozzle system 146, and/or relative to the patient 230.For example, the support elements 251 maintain a second distance, d₂,between a position of the tumor 220 and the third sheet 280 and/ormaintain a third distance, d₃, between a position of the third sheet 280and the scintillation material 210. More generally, support elements 251optionally dynamically position any element about the patient 230relative to one another or in x,y,z-space in a patientdiagnostic/treatment room, such as via computer control.

Referring now to FIG. 4I, positioning the nozzle system 146 of a gantry460 on an opposite side of the patient 230 from a detection surface,such as the scintillation material 210, in a gantry movement system 450is described. Generally, in the gantry movement system 450, as thegantry 460 rotates about an axis the nozzle/nozzle system 146 and/or oneor more magnets of the beam transport system 135 are repositioned. Asillustrated, the nozzle system 146 is positioned by the gantry 460 in afirst position at a first time, t₁, and in a second position at a secondtime, t₂, where n positions are optionally possible. Anelectromechanical system, such as a patient table, patient couch,patient couch, patient rotation device, and/or a scintillation plateholder maintains the patient 230 between the nozzle system 146 and thescintillation material 210 of the tomography system 200. Similarly, notillustrated for clarity of presentation, the electromechanical systemmaintains a position of the third sheet 280 and/or a position of thefourth sheet 290 on a posterior or opposite side of the patient 230 fromthe nozzle 1 system 46 as the gantry 460 rotates or moves the nozzlesystem 146. Similarly, the electromechanical system maintains a positionof the first sheet 260 or first screen and/or a position of the secondsheet 270 or second screen on a same or prior side of the patient 230from the nozzle system 146 as the gantry 460 rotates or moves the nozzlesystem 146. As illustrated, the electromechanical system optionallypositions the first sheet 260 in the positively charged particle path atthe first time, t₁, and rotates, pivots, and/or slides the first sheet260 out of the positively charged particle path at the second time, t₂.The electromechanical system is optionally and preferably connected tothe main controller 110 and/or the treatment delivery control system112. The electromechanical system optionally maintains a fixed distancebetween: (1) the patient and the nozzle system 146 or the nozzle end,(2) the patient 230 or tumor 220 and the scintillation material 210,and/or (3) the nozzle system 146 and the scintillation material 210 at afirst treatment time with the gantry 460 in a first position and at asecond treatment time with the gantry 460 in a second position. Use of acommon charged particle beam path for both imaging and cancer treatmentand/or maintaining known or fixed distances between beam transport/guideelements and treatment and/or detection surface enhances precisionand/or accuracy of a resultant image and/or tumor treatment, such asdescribed supra. Optionally, the gantry comprises a counterweight on anopposite side of an axis of rotation of the gantry. Ideally, thecounterweight results in no net moment of the gantry-counterweightsystem about the axis of rotation of the gantry. In practice, thecounterweight mass and distance forces, herein all elements on one sideof the axis or rotation of the gantry, is within 10, 5, 2, 1, 0.1, or0.01 percent of the mass and distance forces of the section of thegantry on the opposite side of the axis of rotation of the gantry.

System Integration

Any of the systems and/or elements described herein are optionallyintegrated together and/or are optionally integrated with known systems.

Treatment Delivery Control System

Referring now to FIG. 5, a centralized charged particle treatment system500 is illustrated. Generally, once a charged particle therapy plan isdevised, a central control system or treatment delivery control system112 is used to control sub-systems while reducing and/or eliminatingdirect communication between major subsystems. Generally, the treatmentdelivery control system 112 is used to directly control multiplesubsystems of the cancer therapy system without direct communicationbetween selected subsystems, which enhances safety, simplifies qualityassurance and quality control, and facilitates programming. For example,the treatment delivery control system 112 directly controls one or moreof: an imaging system, a positioning system, an injection system, aradio-frequency quadrupole system, a linear accelerator, a ringaccelerator or synchrotron, an extraction system, a beam line, anirradiation nozzle, a gantry, a display system, a targeting system, anda verification system. Generally, the control system integratessubsystems and/or integrates output of one or more of the abovedescribed cancer therapy system elements with inputs of one or more ofthe above described cancer therapy system elements.

Still referring to FIG. 5, an example of the centralized chargedparticle treatment system 1000 is provided. Initially, a doctor, such asan oncologist, prescribes 510 or recommends tumor therapy using chargedparticles.

Subsequently, treatment planning 520 is initiated and output of thetreatment planning step 520 is sent to an oncology information system530 and/or is directly sent to the treatment delivery system 112, whichis an example of the main controller 110.

Still referring to FIG. 5, the treatment planning step 520 is furtherdescribed. Generally, radiation treatment planning is a process where ateam of oncologist, radiation therapists, medical physicists, and/ormedical dosimetrists plan appropriate charged particle treatment of acancer in a patient. Typically, one or more imaging systems 170 are usedto image the tumor and/or the patient, described infra. Planning isoptionally: (1) forward planning and/or (2) inverse planning. Cancertherapy plans are optionally assessed with the aid of a dose-volumehistogram, which allows the clinician to evaluate the uniformity of thedose to the tumor and surrounding healthy structures. Typically,treatment planning is almost entirely computer based using patientcomputed tomography data sets using multimodality image matching, imageco-registration, or fusion.

Forward Planning

In forward planning, a treatment oncologist places beams into aradiotherapy treatment planning system including: how many radiationbeams to use and which angles to deliver each of the beams from. Thistype of planning is used for relatively simple cases where the tumor hasa simple shape and is not near any critical organs.

Inverse Planning

In inverse planning, a radiation oncologist defines a patient's criticalorgans and tumor and gives target doses and importance factors for each.Subsequently, an optimization program is run to find the treatment planwhich best matches all of the input criteria.

Oncology Information System

Still referring to FIG. 5, the oncology information system 530 isfurther described. Generally, the oncology information system 530 is oneor more of: (1) an oncology-specific electronic medical record, whichmanages clinical, financial, and administrative processes in medical,radiation, and surgical oncology departments; (2) a comprehensiveinformation and image management system; and (3) a complete patientinformation management system that centralizes patient data; and (4) atreatment plan provided to the charged particle beam system 100, maincontroller 110, and/or the treatment delivery control system 112.Generally, the oncology information system 530 interfaces withcommercial charged particle treatment systems.

Safety System/Treatment Delivery Control System

Still referring to FIG. 5, the treatment delivery control system 112 isfurther described. Generally, the treatment delivery control system 112receives treatment input, such as a charged particle cancer treatmentplan from the treatment planning step 520 and/or from the oncologyinformation system 530 and uses the treatment input and/or treatmentplan to control one or more subsystems of the charged particle beamsystem 100. The treatment delivery control system 112 is an example ofthe main controller 110, where the treatment delivery control systemreceives subsystem input from a first subsystem of the charged particlebeam system 100 and provides to a second subsystem of the chargedparticle beam system 100: (1) the received subsystem input directly, (2)a processed version of the received subsystem input, and/or (3) acommand, such as used to fulfill requisites of the treatment planningstep 520 or direction of the oncology information system 530. Generally,most or all of the communication between subsystems of the chargedparticle beam system 100 go to and from the treatment delivery controlsystem 112 and not directly to another subsystem of the charged particlebeam system 100. Use of a logically centralized treatment deliverycontrol system has many benefits, including: (1) a single centralizedcode to maintain, debug, secure, update, and to perform checks on, suchas quality assurance and quality control checks; (2) a controlledlogical flow of information between subsystems; (3) an ability toreplace a subsystem with only one interfacing code revision; (4) roomsecurity; (5) software access control; (6) a single centralized controlfor safety monitoring; and (7) that the centralized code results in anintegrated safety system 540 encompassing a majority or all of thesubsystems of the charged particle beam system 100. Examples ofsubsystems of the charged particle cancer therapy system 100 include: aradio frequency quadrupole 550, a radio frequency quadrupole linearaccelerator, the injection system 120, the synchrotron 130, theaccelerator system 131, the extraction system 134, any controllable ormonitorable element of the beam line 268, the targeting/delivery system140, the nozzle system 146, a gantry 560 or an element of the gantry560, the patient interface module 150, a patient positioner 152, thedisplay system 160, the imaging system 170, a patient positionverification system 179, any element described supra, and/or anysubsystem element. A treatment change 570 at time of treatment isoptionally computer generated with or without the aid of a technician orphysician and approved while the patient is still in the treatment room,in the treatment chair, and/or in a treatment position.

Integrated Cancer Treatment—Imaging System

One or more imaging systems 170 are optionally used in a fixed positionin a cancer treatment room and/or are moved with a gantry system, suchas a gantry system supporting: a portion of the beam transport system135, the targeting/delivery control system 140, and/or moving orrotating around a patient positioning system, such as in the patientinterface module. Without loss of generality and to facilitatedescription of the invention, examples follow of an integrated cancertreatment—imaging system. In each system, the beam transport system 135and/or the nozzle system 146 indicates a positively charged beam path,such as from the synchrotron, for tumor treatment and/or for tomography,as described supra.

Example I

Referring now to FIG. 6A, a first example of an integrated cancertreatment—imaging system 600 is illustrated. In this example, thecharged particle beam system 100 is illustrated with a treatment beam269 directed to the tumor 220 of the patient 230 along the z-axis. Alsoillustrated is a set of imaging sources 610, imaging system elements,and/or paths therefrom and a set of detectors 620 corresponding to arespective element of the set of imaging sources 610. Herein, the set ofimaging sources 610 are referred to as sources, but are optionally anypoint or element of the beam train prior to the tumor or a center pointabout which the gantry rotates. Hence, a given imaging source isoptionally a dispersion element used to form cone beam. As illustrated,a first imaging source 612 yields a first beam path 632 and a secondimaging source 614 yields a second beam path 634, where each path passesat least into the tumor 220 and optionally and preferably to a firstdetector array 622 and a second detector array 624, respectively, of theset of detectors 620. Herein, the first beam path 632 and the secondbeam path 634 are illustrated as forming a ninety degree angle, whichyields complementary images of the tumor 220 and/or the patient 230.However, the formed angle is optionally any angle from ten to threehundred fifty degrees. Herein, for clarity of presentation, the firstbeam path 632 and the second beam path 634 are illustrated as singlelines, which optionally is an expanding, uniform diameter, or focusingbeam. Herein, the first beam path 632 and the second beam path 634 areillustrated in transmission mode with their respective sources anddetectors on opposite sides of the patient 230. However, a beam pathfrom a source to a detector is optionally a scattered path and/or adiffuse reflectance path. Optionally, one or more detectors of the setof detectors 620 are a single detector element, a line of detectorelements, or preferably a two-dimensional detector array. Use of twotwo-dimensional detector arrays is referred to herein as atwo-dimensional—two-dimensional imaging system or a 2D-2D imagingsystem.

Still referring to FIG. 6A, the first imaging source 612 and the secondimaging source 614 are illustrated at a first position and a secondposition, respectively. Each of the first imaging source 612 and thesecond imaging source 622 optionally: (1) maintain a fixed position; (2)provide the first beam path(s) 632 and the second beam path(s) 634,respectively, such as to an imaging system detector 620 or through thegantry 460, such as through a set of one or more holes or slits; (3)provide the first beam path 632 and the second beam path 634,respectively, off axis to a plane of movement of the nozzle system 146;(4) move with the gantry 460 as the gantry 460 rotates about at least afirst axis; (5) move with a secondary imaging system independent ofmovement of the gantry, as described supra; and/or (6) represent anarrow cross-diameter section of an expanding cone beam path.

Still referring to FIG. 6A, the set of detectors 620 are illustrated ascoupling with respective elements of the set of sources 610. Each memberof the set of detectors 620 optionally and preferably co-moves/and/orco-rotates with a respective member of the set of sources 610. Thus, ifthe first imaging source 612 is statically positioned, then the firstdetector 622 is optionally and preferably statically positioned.Similarly, to facilitate imaging, if the first imaging source 612 movesalong a first arc as the gantry 460 moves, then the first detector 622optionally and preferably moves along the first arc or a second arc asthe gantry 460 moves, where relative positions of the first imagingsource 612 on the first arc, a point that the gantry 460 moves about,and relative positions of the first detector 622 along the second arcare constant. To facilitate the process, the detectors are optionallymechanically linked, such as with a mechanical support to the gantry 460in a manner that when the gantry 460 moves, the gantry moves both thesource and the corresponding detector. Optionally, the source moves anda series of detectors, such as along the second arc, capture a set ofimages. As illustrated in FIG. 6A, the first imaging source 612, thefirst detector array 622, the second imaging source 614, and the seconddetector array 624 are coupled to a rotatable imaging system support462, which optionally rotates independently of the gantry 460 as furtherdescribed infra. As illustrated in FIG. 6B, the first imaging source612, the first detector array 622, the second imaging source 614, andthe second detector array 624 are coupled to the gantry 460, which inthis case is a rotatable gantry.

Still referring to FIG. 6A, optionally and preferably, elements of theset of sources 610 combined with elements of the set of detectors 620are used to collect a series of responses, such as one source and onedetector yielding a detected intensity and rotatable imaging systemsupport 462 preferably a set of detected intensities to form an image.For instance, the first imaging source 612, such as a first X-ray sourceor first cone beam X-ray source, and the first detector 622, such as anX-ray film, digital X-ray detector, or two-dimensional detector, yield afirst X-ray image of the patient at a first time and a second X-rayimage of the patient at a second time, such as to confirm a maintainedlocation of a tumor or after movement of the gantry and/or nozzle system146 or rotation of the patient 230. A set of n images using the firstimaging source 612 and the first detector 622 collected as a function ofmovement of the gantry and/or the nozzle system 146 supported by thegantry and/or as a function of movement and/or rotation of the patient230 are optionally and preferably combined to yield a three-dimensionalimage of the patient 230, such as a three-dimensional X-ray image of thepatient 230, where n is a positive integer, such as greater than 1, 2,3, 4, 5, 10, 15, 25, 50, or 100. The set of n images is optionallygathered as described in combination with images gathered using thesecond imaging source 614, such as a second X-ray source or second conebeam X-ray source, and the second detector 624, such as a second X-raydetector, where the use of two, or multiple, source/detectorcombinations are combined to yield images where the patient 230 has notmoved between images as the two, or the multiple, images are optionallyand preferably collected at the same time, such as with a difference intime of less than 0.01, 0.1, 1, or 5 seconds. Longer time differencesare optionally used. Preferably the n two-dimensional images arecollected as a function of rotation of the gantry 460 about the tumorand/or the patient and/or as a function of rotation of the patient 230and the two-dimensional images of the X-ray cone beam are mathematicallycombined to form a three-dimensional image of the tumor 220 and/or thepatient 230. Optionally, the first X-ray source and/or the second X-raysource is the source of X-rays that are divergent forming a cone throughthe tumor. A set of images collected as a function of rotation of thedivergent X-ray cone around the tumor with a two-dimensional detectorthat detects the divergent X-rays transmitted through the tumor is usedto form a three-dimensional X-ray of the tumor and of a portion of thepatient, such as in X-ray computed tomography.

Still referring to FIG. 6A, use of two imaging sources and two detectorsset at ninety degrees to one another allows the gantry 460 or thepatient 230 to rotate through half an angle required using only oneimaging source and detector combination. A third imaging source/detectorcombination allows the three imaging source/detector combination to beset at sixty degree intervals allowing the imaging time to be cut tothat of one-third that gantry 460 or patient 230 rotation required usinga single imaging source-detector combination. Generally, nsource-detector combinations reduces the time and/or the rotationrequirements to 1/n. Further reduction is possible if the patient 230and the gantry 460 rotate in opposite directions. Generally, the used ofmultiple source-detector combination of a given technology allow for agantry that need not rotate through as large of an angle, with dramaticengineering benefits.

Still referring to FIG. 6A, the set of sources 610 and set of detectors620 optionally use more than one imaging technology. For example, afirst imaging technology uses X-rays, a second used fluoroscopy, a thirddetects fluorescence, a fourth uses cone beam computed tomography orcone beam CT, and a fifth uses other electromagnetic waves. Optionally,the set of sources 610 and the set of detectors 620 use two or moresources and/or two or more detectors of a given imaging technology, suchas described supra with two X-ray sources to n X-ray sources.

Still referring to FIG. 6A, use of one or more of the set of sources 610and use of one or more of the set of detectors 620 is optionally coupledwith use of the positively charged particle tomography system describedsupra. As illustrated in FIG. 6A, the positively charged particletomography system uses a second mechanical support 643 to co-rotate thescintillation material 210 with the gantry 460, as well as to co-rotatean optional sheet, such as the first sheet 260 and/or the fourth sheet290.

Example II

Referring now to FIG. 6B, a second example of the integrated cancertreatment—imaging system 600 is illustrated using greater than threeimagers.

Still referring to FIG. 6B, two pairs of imaging systems areillustrated. Particularly, the first and second imaging source 612, 614coupled to the first and second detectors 622, 624 are as describedsupra. For clarity of presentation and without loss of generality, thefirst and second imaging systems are referred to as a first X-rayimaging system and a second X-ray imaging system. The second pair ofimaging systems uses a third imaging source 616 coupled to a thirddetector 626 and a fourth imaging source 618 coupled to a fourthdetector 628 in a manner similar to the first and second imaging systemsdescribed in the previous example. Here, the second pair of imagingsystems optionally and preferably uses a second imaging technology, suchas fluoroscopy. Optionally, the second pair of imaging systems is asingle unit, such as the third imaging source 616 coupled to the thirddetector 626, and not a pair of units. Optionally, one or more of theset of imaging sources 610 are statically positioned while one of moreof the set of imaging sources 610 co-rotate with the gantry 460. Pairsof imaging sources/detector optionally have common and distinctdistances, such as a first distance, d₁, such as for a firstsource-detector pair and a second distance, d₂, such as for a secondsource-detector or second source-detector pair. As illustrated, thetomography detector or the scintillation material 210 is at a thirddistance, d₃. The distinct differences allow the source-detectorelements to rotate on a separate rotation system at a rate differentfrom rotation of the gantry 460, which allows collection of a fullthree-dimensional image while tumor treatment is proceeding with thepositively charged particles.

Example III

For clarity of presentation, referring now to FIG. 6C, any of the beamsor beam paths described herein is optionally a cone beam 690 asillustrated. The patient support 152 is an mechanical and/orelectromechanical device used to position, rotate, and/or constrain anyportion of the tumor 220 and/or the patient 230 relative to any axis.

Tomography Detector System

A tomography system optically couples the scintillation material to adetector. As described, supra, the tomography system optionally andpreferably uses one or more detection sheets, beam tracking elements,and/or tracking detectors to determine/monitor the charged particle beamposition, shape, and/or direction in the beam path prior to and/orposterior to the sample, imaged element, patient, or tumor. Herein,without loss of generality, the detector is described as a detectorarray or two-dimensional detector array positioned next to thescintillation material; however, the detector array is optionallyoptically coupled to the scintillation material using one or moreoptics. Optionally and preferably, the detector array is a component ofan imaging system that images the scintillation material 210, where theimaging system resolves an origin volume or origin position on a viewingplane of the secondary photon emitted resultant from passage of theresidual charged particle beam 267. As described, infra, more than onedetector array is optionally used to image the scintillation material210 from more than one direction, which aids in a three-dimensionalreconstruction of the photonic point(s) of origin, positively chargedparticle beam path, and/or tomographic image.

Imaging

Generally, medical imaging is performed using an imaging apparatus togenerate a visual and/or a symbolic representation of an interiorconstituent of the body for diagnosis, treatment, and/or as a record ofstate of the body. Typically, one or more imaging systems are used toimage the tumor and/or the patient. For example, the X-ray imagingsystem and/or the positively charged particle imaging system, describedsupra, are optionally used individually, together, and/or with anyadditional imaging system, such as use of X-ray radiography, magneticresonance imaging, medical ultrasonography, thermography, medicalphotography, positron emission tomography (PET) system, single-photonemission computed tomography (SPECT), and/or another nuclear/chargedparticle imaging technique.

Fiducial Marker

Fiducial markers and fiducial detectors are optionally used to locate,target, track, avoid, and/or adjust for objects in a treatment room thatmove relative to the nozzle or nozzle system 146 of the charged particlebeam system 100 and/or relative to each other. Herein, for clarity ofpresentation and without loss of generality, fiducial markers andfiducial detectors are illustrated in terms of a movable or staticallypositioned treatment nozzle and a movable or static patient position.However, generally, the fiducial markers and fiducial detectors are usedto mark and identify position, or relative position, of any object in atreatment room, such as a cancer therapy treatment room 922. Herein, afiducial indicator refers to either a fiducial marker or a fiducialdetector. Herein, photons travel from a fiducial marker to a fiducialdetector.

Herein, fiducial refers to a fixed basis of comparison, such as a pointor a line. A fiducial marker or fiducial is an object placed in thefield of view of an imaging system, which optionally appears in agenerated image or digital representation of a scene, area, or volumeproduced for use as a point of reference or as a measure. Herein, afiducial marker is an object placed on, but not into, a treatment roomobject or patient. Particularly, herein, a fiducial marker is not animplanted device in a patient. In physics, fiducials are referencepoints: fixed points or lines within a scene to which other objects canbe related or against which objects can be measured. Fiducial markersare observed using a sighting device for determining directions ormeasuring angles, such as an alidade or in the modern era a digitaldetection system. Two examples of modern position determination systemsare the Passive Polaris Spectra System and the Polaris Vicra System(NDI, Ontario, Canada).

Referring now to FIG. 7A, use of a fiducial marker system 700 isdescribed. Generally, a fiducial marker is placed 710 on an object,light from the fiducial marker is detected 730, relative objectpositions are determined 740, and a subsequent task is performed, suchas treating a tumor 770. For clarity of presentation and without loss ofgenerality, non-limiting examples of uses of fiducial markers incombination with X-ray and/or positively charged particle tomographicimaging and/or treatment using positively charged particles areprovided, infra.

Example I

Referring now to FIG. 8, a fiducial marker aided tomography system 800is illustrated and described. Generally, a set of fiducial markerdetectors 820 detects photons emitted from and/or reflected off of a setof fiducial markers 810 and resultant determined distances andcalculated angles are used to determine relative positions of multipleobjects or elements, such as in the treatment room 922.

Still referring to FIG. 8, initially, a set of fiducial markers 810 areplaced on one or more elements. As illustrated, a first fiducial marker811, a second fiducial marker 812, and a third fiducial marker 813 arepositioned on a first, preferably rigid, support element 852. Asillustrated, the first support element 852 supports a scintillationmaterial 210. As each of the first, second, and third fiducial markers811, 812, 813 and the scintillation material 210 are affixed orstatically positioned onto the first support element 852, the relativeposition of the scintillation material 210 is known, based on degrees offreedom of movement of the first support element, if the positions ofthe first fiducial marker 811, the second fiducial marker 812, and/orthe third fiducial marker 813 is known. In this case, one or moredistances between the first support element 852 and a third supportelement 856 are determined, as further described infra.

Still referring to FIG. 8, a set of fiducial detectors 820 are used todetect light emitted from and/or reflected off one or more fiducialmarkers of the set of fiducial markers 810. As illustrated, ambientphotons 821 and/or photons from an illumination source reflect off ofthe first fiducial marker 811, travel along a first fiducial path 831,and are detected by a first fiducial detector 821 of the set of fiducialdetectors 820. In this case, a first signal from the first fiducialdetector 821 is used to determine a first distance to the first fiducialmarker 811. If the first support element 852 supporting thescintillation material 210 only translates, relative to the nozzlesystem 146, along the z-axis, the first distance is sufficientinformation to determine a location of the scintillation material 210,relative to the nozzle system 146. Similarly, photons emitted, such asfrom a light emitting diode embedded into the second fiducial marker 812travel along a second fiducial path 832 and generate a second signalwhen detected by a second fiducial detector 822, of the set of fiducialdetectors 820. The second signal is optionally used to confirm positionof the first support element 852, reduce error of a determined positionof the first support element 852, and/or is used to determine extent ofa second axis movement of the first support element 852, such as tilt ofthe first support element 852. Similarly, photons passing from the thirdfiducial marker 813 travel along a third fiducial path 833 and generatea third signal when detected by a third fiducial detector 823, of theset of fiducial detectors 820. The third signal is optionally used toconfirm position of the first support element 852, reduce error of adetermined position of the first support element 852, and/or is used todetermine extent of a second or third axis movement of the first supportelement 852, such as rotation of the first support element 852.

If all of the movable elements within the treatment room 922 movetogether, then determination of a position of one, two, or threefiducial markers, dependent on degrees of freedom of the movableelements, is sufficient to determine a position of all of the co-movablemovable elements. However, optionally two or more objects in thetreatment room 922 move independently or semi-independently from oneanother. For instance, a first movable object optionally translates,tilts, and/or rotates relative to a second movable object. One or moreadditional fiducial markers of the set of fiducial markers 810 placed oneach movable object allows relative positions of each of the movableobjects to be determined.

Still referring to FIG. 8, a position of the patient 230 is determinedrelative to a position of the scintillation material 210. Asillustrated, a second support element 854 positioning the patient 230optionally translates, tilts, and/or rotates relative to the firstsupport element 852 positioning the scintillation material 210. In thiscase, a fourth fiducial marker 814, attached to the second supportelement 854 allows determination of a current position of the patient230. As illustrated, a position of a single fiducial element, the fourthfiducial marker 814, is determined by the first fiducial detector 821determining a first distance to the fourth fiducial marker 814 and thesecond fiducial detector 822 determining a second distance to the fourthfiducial marker 814, where a first arc of the first distance from thefirst fiducial detector 821 and a second arc of the second distance fromthe second fiducial detector 822 overlap at a point of the fourthfiducial marker 834 marking the position of the second support element852 and the supported position of the patient 230. Combined with theabove described system of determining location of the scintillationmaterial 210, the relative position of the scintillation material 210 tothe patient 230, and thus the tumor 720, is determined.

Still referring to FIG. 8, one fiducial marker and/or one fiducialdetector is optionally and preferably used to determine more than onedistance or angle to one or more objects. In a first case, asillustrated, light from the fourth fiducial marker 814 is detected byboth the first fiducial detector 821 and the second fiducial detector822. In a second case, as illustrated, light detected by the firstfiducial detector 821, passes from the first fiducial marker 811 and thefourth fiducial marker 814. Thus, (1) one fiducial marker and twofiducial detectors are used to determine a position of an object, (2)two fiducial markers on two elements and one fiducial detector is usedto determine relative distances of the two elements to the singledetector, and/or as illustrated and described below in relation to FIG.10A, and/or (3) positions of two or more fiducial markers on a singleobject are detected using a single fiducial detector, where the distanceand orientation of the single object is determined from the resultantsignals. Generally, use of multiple fiducial markers and multiplefiducial detectors are used to determine or overdetermine positions ofmultiple objects, especially when the objects are rigid, such as asupport element, or semi-rigid, such as a person, head, torso, or limb.

Still referring to FIG. 8, the fiducial marker aided tomography system800 is further described. As illustrated, the set of fiducial detectors820 are mounted onto the third support element 856, which has a knownposition and orientation relative to the nozzle system 146. Thus,position and orientation of the nozzle system 146 is known relative tothe tumor 720, the patient 230, and the scintillation material 210through use of the set of fiducial markers 810, as described supra.Optionally, the main controller 110 uses inputs from the set of fiducialdetectors 820 to: (1) dictate movement of the patient 230 or operator;(2) control, adjust, and/or dynamically adjust position of any elementwith a mounted fiducial marker and/or fiducial detector, and/or (3)control operation of the charged particle beam, such as for imagingand/or treating or performing a safety stop of the positively chargedparticle beam. Further, based on past movements, such as the operatormoving across the treatment room 922 or relative movement of twoobjects, the main controller is optionally and preferably used toprognosticate or predict a future conflict between the treatment beam269 and the moving object, in this case the operator, and takeappropriate action or to prevent collision of the two objects.

Example II

Referring now to FIG. 9, a fiducial marker aided treatment system 3400is described. To clarify the invention and without loss of generality,this example uses positively charged particles to treat a tumor.However, the methods and apparatus described herein apply to imaging asample, such as described supra.

Still referring to FIG. 9, four additional cases of fiducialmarker—fiducial detector combinations are illustrated. In a first case,photons from the first fiducial marker 811 are detected using the firstfiducial detector 821, as described in the previous example. However,photons from a fifth fiducial marker 815 are blocked and prevented fromreaching the first fiducial detector 821 as a sixth fiducial path 836 isblocked, in this case by the patient 230. The inventor notes that theabsence of an expected signal, disappearance of a previously observedsignal with the passage of time, and/or the emergence of a new signaleach add information on existence and/or movement of an object. In asecond case, photons from the fifth fiducial marker 815 passing along aseventh fiducial path 837 are detected by the second fiducial detector822, which illustrates one fiducial marker yielding a blocked andunblocked signal usable for finding an edge of a flexible element or anelement with many degrees of freedom, such as a patient's hand, arm, orleg. In a third case, photons from the fifth fiducial marker 815 and asixth fiducial marker 816, along the seventh fiducial path 837 and aneighth fiducial path 838 respectively, are detected by the secondfiducial detector 822, which illustrates that one fiducial detectoroptionally detects signals from multiple fiducial markers. In this case,photons from the multiple fiducial sources are optionally of differentwavelengths, occur at separate times, occur for different overlappingperiods of time, and/or are phase modulated. In a fourth case, a seventhfiducial marker 817 is affixed to the same element as a fiducialdetector, in this case the front surface plane of the third supportelement 856. Also, in the fourth case, a fourth fiducial detector 824,observing photons along a ninth fiducial path 839, is mounted to afourth support element 858, where the fourth support element 858positions the patient 230 and tumor 220 thereof and/or is attached toone or more fiducial source elements.

Still referring to FIG. 9 the fiducial marker aided treatment system 900is further described. As described, supra, the set of fiducial markers810 and the set of fiducial detectors 820 are used to determine relativelocations of objects in the treatment room 922, which are the thirdsupport element 856, the fourth support element 858, the patient 230,and the tumor 220 as illustrated. Further, as illustrated, the thirdsupport element 856 comprises a known physical position and orientationrelative to the nozzle system 146. Hence, using signals from the set offiducial detectors 820, representative of positions of the fiducialmarkers 810 and room elements, the main controller 110 controls thetreatment beam 269 to target the tumor 220 as a function of time,movement of the nozzle system 146, and/or movement of the patient 230.

Example III

Referring now to FIG. 10A, a fiducial marker aided treatment room system1000 is described. Without loss of generality and for clarity ofpresentation, a zero vector 1001 is a vector or line emerging from thenozzle system 146 when the first axis control 143, such as a verticalcontrol, and the second axis control 144, such as a horizontal control,of the scanning system 140 is turned off. Without loss of generality andfor clarity of presentation, a zero point 1002 is a point on the zerovector 1001 at a plane of an exit face the nozzle system 146. Generally,a defined point and/or a defined line are used as a reference positionand/or a reference direction and fiducial markers are defined in spacerelative to the point and/or line.

Six additional cases of fiducial marker—fiducial detector combinationsare illustrated to further describe the fiducial marker aided treatmentroom system 1000. In a first case, the patient 230 position isdetermined. Herein, a first fiducial marker 811 marks a position of apatient positioning device 1020 and a second fiducial marker 812 marks aposition of a portion of skin of the patient 230, such as a limb, joint,and/or a specific position relative to the tumor 220. In a second case,multiple fiducial markers of the set of fiducial markers 810 andmultiple fiducial detectors of said set of fiducial detectors 820 areused to determine a position/relative position of a single object, wherethe process is optionally and preferably repeated for each object in thetreatment room 922. As illustrated, the patient 230 is marked with thesecond fiducial marker 812 and a third fiducial marker 813, which aremonitored using a first fiducial detector 821 and a second fiducialdetector 822. In a third case, a fourth fiducial marker 814 marks thescintillation material 210 and a sixth fiducial path 836 illustratesanother example of a blocked fiducial path. In a fourth case, a fifthfiducial marker 815 marks an object not always present in the treatmentroom, such as a wheelchair 1040, walker, or cart. In a sixth case, asixth fiducial marker 816 is used to mark an operator 1050, who ismobile and must be protected from an unwanted irradiation from thenozzle system 146.

Still referring to FIG. 10A, clear field treatment vectors andobstructed field treatment vectors are described. A clear fieldtreatment vector comprises a path of the treatment beam 269 that doesnot intersect a non-standard object, where a standard object includesall elements in a path of the treatment beam 269 used to measure aproperty of the treatment beam 269, such as the first sheet 260, thesecond sheet 270, the third sheet 280, and the fourth sheet 290.Examples of non-standard objects or interfering objects include an armof the patient couch, a back of the patient couch, and/or a supportingbar, such a robot arm. Use of fiducial indicators, such as a fiducialmarker, on any potential interfering object allows the main controller110 to only treat the tumor 220 of the patient 230 in the case of aclear field treatment vector. For example, fiducial markers areoptionally placed along the edges or corners of the patient couch orpatient positioning system or indeed anywhere on the patient couch.Combined with a-priori knowledge of geometry of the non-standard object,the main controller can deduce/calculate presence of the non-standardobject in a current or future clear field treatment vector, forming aobstructed field treatment vector, and perform any of: increasing energyof the treatment beam 269 to compensate, moving the interferingnon-standard object, and/or moving the patient 230 and/or the nozzlesystem 146 to a new position to yield a clear field treatment vector.Similarly, for a given determined clear filed treatment vector, a totaltreatable area, using scanning of the proton beam, for a givennozzle-patient couch position is optionally and preferably determined.Further, the clear field vectors are optionally and preferablypredetermined and used in development of a radiation treatment plan.

Referring again to FIG. 7A, FIG. 8, FIG. 9, and FIG. 10A, generally, oneor more fiducial markers and/or one or more fiducial detectors areattached to any movable and/or statically positioned object/element inthe treatment room 922, which allows determination of relative positionsand orientation between any set of objects in the treatment room 922.

Sound emitters and detectors, radar systems, and/or any range and/ordirectional finding system is optionally used in place of thesource-photon-detector systems described herein.

2D-2D X-Ray Imaging

Still referring to FIG. 10A, for clarity of presentation and withoutloss of generality, a two-dimensional-two-dimensional (2D-2D) X-rayimaging system 1060 is illustrated, which is representative of anysource-sample-detector transmission based imaging system. Asillustrated, the 2D-2D imaging system 1060 includes a 2D-2D source end1062 on a first side of the patient 230 and a 2D-2D detector end 1064 ona second side, an opposite side, of the patient 230. The 2D-2D sourceend 1062 holds, positions, and/or aligns source imaging elements, suchas: (1) one or more imaging sources; (2) the first imaging source 612and the second imaging source 622; and/or (3) a first cone beam X-raysource and a second cone beam X-ray source; while, the 2D-2D detectorend 1064, respectively, holds, positions, and/or aligns: (1) one or moreimaging detectors 1066; (2) a first imaging detector and a secondimaging detector; and/or (3) a first cone beam X-ray detector and asecond cone beam X-ray detector.

In practice, optionally and preferably, the 2D-2D imaging system 1060 asa unit rotates about a first axis around the patient, such as an axis ofthe treatment beam 269, as illustrated at the second time, t₂. Forinstance, at the second time, t₂, the 2D-2D source end 1062 moves up andout of the illustrated plane while the 2D-2D detector end 1064 movesdown and out of the illustrated plane. Thus, the 2D-2D imaging systemmay operate at one or more positions through rotation about the firstaxis while the treatment beam 269 is in operation without interferingwith a path of the treatment beam 269.

Optionally and preferably, the 2D-2D imaging system 1060 does notphysically obstruct the treatment beam 269 or associated residual energyimaging beam from the nozzle system 146. Through relative movement ofthe nozzle system 146 and the 2D-2D imaging system 1060, a mean path ofthe treatment beam 269 and a mean path of X-rays from an X-ray source ofthe 2D-2D imaging system 1060 form an angle from 0 to 90 degrees andmore preferably an angle of greater than 10, 20, 30, or 40 degrees andless than 80, 70, or 60 degrees.

Still referring to FIG. 10A, as illustrated at the second time, t₂, theangle between the mean treatment beam and the mean X-ray beam is 45degrees.

The 2D-2D imaging system 1060 optionally rotates about a second axis,such as an axis perpendicular to FIG. 10A and passing through thepatient and/or passing through the first axis. Thus, as illustrated, asthe exit port of the output nozzle system 146 moves along an arc and thetreatment beam 269 enters the patient 230 from another angle, rotationof the 2D-2D imaging system 1060 about the second axis perpendicular toFIG. 10A, the first axis of the 2D-2D imaging system 1060 continues torotate about the first axis, where the first axis is the axis of thetreatment beam 269 or the residual charged particle beam 267 in the caseof imaging with protons.

Optionally and preferably, one or more elements of the 2D-2D X-rayimaging system 1060 are marked with one or more fiducial elements, asdescribed supra. As illustrated, the 2D-2D detector end 1064 isconfigured with a seventh fiducial marker 817 and an eighth fiducialmarker 818 while the 2D-2D source end 1062 is configured with a ninthfiducial marker 819, where any number of fiducial markers are used.

In many cases, movement of one fiducial indicator necessitates movementof a second fiducial indicator as the two fiducial indicators arephysically linked. Thus, the second fiducial indicator is not strictlyneeded, given complex code that computes the relative positions offiducial markers that are often being rotated around the patient 230,translated past the patient 230, and/or moved relative to one or moreadditional fiducial markers. The code is further complicated by movementof non-mechanically linked and/or independently moveable obstructions,such as a first obstruction object moving along a first concentric pathand a second obstruction object moving along a second concentric path.

The inventor notes that the complex position determination code isgreatly simplified if the treatment beam path 269 to the patient 230 isdetermined to be clear of obstructions, through use of the fiducialindicators, prior to treatment of at least one of and preferably everyvoxel of the tumor 220. Thus, multiple fiducial markers placed onpotentially obstructing objects simplifies the code and reducestreatment related errors. Typically, treatment zones or treatment conesare determined where a treatment cone from the output nozzle system 146to the patient 230 does not pass through any obstructions based on thecurrent position of all potentially obstructing objects, such as asupport element of the patient couch. As treatment cones overlap, thepath of the treatment beam 269 and/or a path of the residual chargedparticle beam 267 is optionally moved from treatment cone to treatmentcone without use of the imaging/treatment beam continuously as movedalong an arc about the patient 230. A transform of the standardtomography algorithm thus allows physical obstructions to theimaging/treatment beam to be avoided.

Isocenterless System

The inventor notes that a fiducial marker aided imaging system, thefiducial marker aided tomography system 800, and/or the fiducial markeraided treatment system 900 are applicable in a treatment room 922 nothaving a treatment beam isocenter, not having a tumor isocenter, and/oris not reliant upon calculations using and/or reliant upon an isocenter.Further, the inventor notes that all positively charged particle beamtreatment centers in the public view are based upon mathematical systemsusing an isocenter for calculations of beam position and/or treatmentposition and that the fiducial marker aided imaging and treatmentsystems described herein do not need an isocenter and are notnecessarily based upon mathematics using an isocenter, as is furtherdescribed infra. In stark contrast, a defined point and/or a definedline are used as a reference position and/or a reference direction andfiducial markers are defined in space relative to the point and/or line.

Traditionally, the isocenter 263 of a gantry based charged particlecancer therapy system is a point in space about which an output nozzlerotates. In theory, the isocenter 263 is an infinitely small point inspace. However, traditional gantry and nozzle systems are large andextremely heavy devices with mechanical errors associated with eachelement. In real life, the gantry and nozzle rotate around a centralvolume, not a point, and at any given position of the gantry-nozzlesystem, a mean or unaltered path of the treatment beam 269 passesthrough a portion of the central volume, but not necessarily the singlepoint of the isocenter 263. Thus, to distinguish theory and real-life,the central volume is referred to herein as a mechanically definedisocenter volume, where under best engineering practice the isocenterhas a geometric center, the isocenter 263. Further, in theory, as thegantry-nozzle system rotates around the patient, the mean or unalteredlines of the treatment beam 269 at a first and second time, preferablyall times, intersect at a point, the point being the isocenter 263,which is an unknown position. However, in practice the lines passthrough the mechanically identified isocenter volume 1012. The inventornotes that in all gantry supported movable nozzle systems, calculationsof applied beam state, such as energy, intensity, and direction of thecharged particle beam, are calculated using a mathematical assumption ofthe point of the isocenter 263. The inventor further notes, that as inpractice the treatment beam 269 passes through the mechanically definedisocenter volume but misses the isocenter 263, an error exists betweenthe actual treatment volume and the calculated treatment volume of thetumor 220 of the patient 230 at each point in time. The inventor stillfurther notes that the error results in the treatment beam 269: (1) notstriking a given volume of the tumor 220 with the prescribed energyand/or (2) striking tissue outside of the tumor. Mechanically, thiserror cannot be eliminated, only reduced. However, use of the fiducialmarkers and fiducial detectors, as described supra, removes theconstraint of using an unknown position of the isocenter 263 todetermine where the treatment beam 269 is striking to fulfill a doctorprovided treatment prescription as the actual position of the patientpositioning system, tumor 220, and/or patient 230 is determined usingthe fiducial markers and output of the fiducial detectors with no use ofthe isocenter 263, no assumption of an isocenter 263, and/or no spatialtreatment calculation based on the isocenter 263. Rather, a physicallydefined point and/or line, such as the zero point 1002 and/or the zerovector 1001, in conjunction with the fiducials are used to: (1)determine position and/or orientation of objects relative to the pointand/or line and/or (2) perform calculations, such as a radiationtreatment plan.

Referring again to FIG. 7A and referring again to FIG. 10A, optionallyand preferably, the task of determining the relative object positions740 uses a fiducial element, such as an optical tracker, mounted in thetreatment room 922, such as on the gantry or nozzle system, andcalibrated to a “zero” vector 1001 of the treatment beam 269, which isdefined as the path of the treatment beam when electromagnetic and/orelectrostatic steering of one or more final magnets in the beamtransport system 135 and/or an output nozzle system 146 attached to aterminus thereof is/are turned off. The zero vector 1001 is a path ofthe treatment beam 269 when the first axis control 143, such as avertical control, and the second axis control 144, such as a horizontalcontrol, of the scanning system 140 is turned off. A zero point 1002 isany point, such as a point on the zero vector 1001. Herein, without lossof generality and for clarity of presentation, the zero point 1002 is apoint on the zero vector 1001 crossing a plane defined by a terminus ofthe nozzle of the nozzle system 146. Ultimately, the use of a zerovector 1001 and/or the zero point 1002 is a method of directly andoptionally actively relating the coordinates of objects, such as movingobjects and/or the patient 230 and tumor 220 thereof, in the treatmentroom 922 to one another; not passively relating them to an imaginarypoint in space such as a theoretical isocenter than cannot mechanicallybe implemented in practice as a point in space, but rather always as ana isocenter volume, such as an isocenter volume including the isocenterpoint in a well-engineered system. Examples further distinguish theisocenter based and fiducial marker based targeting system.

Example I

Referring now to FIG. 10B, an isocenterless system 1005 of the fiducialmarker aided treatment room system 1000 of FIG. 10A is described. Asillustrated, the nozzle/nozzle system 146 is positioned relative to areference element, such as the third support element 856. The referenceelement is optionally a reference fiducial marker and/or a referencefiducial detector affixed to any portion of the nozzle system 146 and/ora rigid, positionally known mechanical element affixed thereto. Aposition of the tumor 220 of the patient 230 is also determined usingfiducial markers and fiducial detectors, as described supra. Asillustrated, at a first time, t₁, a first mean path of the treatmentbeam 269 passes through the isocenter 263. At a second time, t₂,resultant from inherent mechanical errors associated with moving thenozzle system 146, a second mean path of the treatment beam 269 does notpass through the isocenter 263. In a traditional system, this wouldresult in a treatment volume error. However, using the fiducial markerbased system, the actual position of the nozzle system 146 and thepatient 230 is known at the second time, t₂, which allows the maincontroller to direct the treatment beam 269 to the targeted andprescription dictated tumor volume using the first axis control 143,such as a vertical control, and the second axis control 144, such as ahorizontal control, of the scanning system 140. Again, since the actualposition at the time of treatment is known using the fiducial markersystem, mechanical errors of moving the nozzle system 146 are removedand the x/y-axes adjustments of the treatment beam 269 are made usingthe actual and known position of the nozzle system 146 and the tumor220, in direct contrast to the x/y-axes adjustments made in traditionalsystems, which assume that the treatment beam 269 passes through theisocenter 263. In essence: (1) the x/y-axes adjustments of thetraditional targeting systems are in error as the unmodified treatmentbeam 269 is not passing through the assumed isocenter and (2) thex/y-axes adjustments of the fiducial marker based system know the actualposition of the treatment beam 269 relative to the patient 230 and thetumor 220 thereof, which allows different x/y-axes adjustments thatadjust the treatment beam 269 to treat the prescribed tumor volume withthe prescribed dosage.

Example II

Referring now to FIG. 10C an example is provided that illustrates errorsin an isocenter 263 with a fixed beamline position and a moving patientpositioning system. As illustrated, at a first time, t₁, themean/unaltered treatment beam path 269 passes through the tumor 220, butmisses the isocenter 263. As described, supra, traditional treatmentsystems assume that the mean/unaltered treatment beam path 269 passesthrough the isocenter 263 and adjust the treatment beam to a prescribedvolume of the tumor 220 for treatment, where both the assumed paththrough the isocenter and the adjusted path based on the isocenter arein error. In stark contrast, the fiducial marker system: (1) determinesthat the actual mean/unaltered treatment beam path 269 does not passthrough the isocenter 263, (2) determines the actual path of themean/unaltered treatment beam 269 relative to the tumor 220, and (3)adjusts, using a reference system such as the zero line 1001 and/or thezero point 1002, the actual mean/unaltered treatment beam 269 to strikethe prescribed tissue volume using the first axis control 143, such as avertical control, and the second axis control 144, such as a horizontalcontrol, of the scanning system 140. As illustrated, at a second time,t₂, the mean/unaltered treatment beam path 269 again misses theisocenter 263 resulting in treatment errors in the traditional isocenterbased targeting systems, but as described, the steps of: (1) determiningthe relative position of: (a) the mean/unaltered treatment beam 269 and(b) the patient 230 and tumor 220 thereof and (2) adjusting thedetermined and actual mean/unaltered treatment beam 269, relative to thetumor 220, to strike the prescribed tissue volume using the first axiscontrol 143, the second axis control 144, and energy of the treatmentbeam 269 are repeated for the second time, t₂, and again through then^(th) treatment time, where n is a positive integer of at least 5, 10,50, 100, or 500.

Referring again to FIG. 8 and FIG. 9, generally at a first time,objects, such as the patient 230, the scintillation material 210, anX-ray system, and the nozzle system 146 are mapped and relativepositions are determined. At a second time, the position of the mappedobjects is used in imaging, such as X-ray and/or proton beam imaging,and/or treatment, such as cancer treatment. Further, an isocenter isoptionally used or is not used. Still further, the treatment room 922is, due to removal of the beam isocenter knowledge constraint,optionally designed with a static or movable nozzle system 146 inconjunction with any patient positioning system along any set of axes aslong as the fiducial marking system is utilized.

Referring now to FIG. 7B, optional uses of the fiducial marker system700 are described. After the initial step of placing the fiducialmarkers 710, the fiducial markers are optionally illuminated 720, suchas with the ambient light or external light as described above. Lightfrom the fiducial markers is detected 730 and used to determine relativepositions of objects 740, as described above. Thereafter, the objectpositions are optionally adjusted 750, such as under control of the maincontroller 110 and the step of illuminating the fiducial markers 720and/or the step of detecting light from the fiducial markers 730 alongwith the step of determining relative object positions 740 isiteratively repeated until the objects are correctly positioned.Simultaneously or independently, fiducial detectors positions areadjusted 780 until the objects are correctly placed, such as fortreatment of a particular tumor voxel. Using any of the above steps: (1)one or more images are optionally aligned 760, such as a collected X-rayimage and a collected proton tomography image using the determinedpositions; (2) the tumor 220 is treated 770; and/or (3) changes of thetumor 220 are tracked 790 for dynamic treatment changes and/or thetreatment session is recorded for subsequent analysis.

Referenced Charged Particle Path

Referring now to FIG. 11, a charged particle reference beam path system1100 is described, which starkly contrasts to an isocenter referencepoint of a gantry system, as described supra. The charged particlereference beam path system 1100 defines voxels in the treatment room922, the patient 230, and/or the tumor 220 relative to a reference pathof the positively charged particles and/or a transform thereof. Thereference path of the positively charged particles comprises one or moreof: a zero vector, an unredirected beamline, an unsteered beamline, anominal path of the beamline, and/or, such as, in the case of arotatable gantry and/or moveable nozzle, a translatable and/or arotatable position of the zero vectors. For clarity of presentation andwithout loss of generality, the terminology of a reference beam path isused herein to refer to an axis system defined by the charged particlebeam under a known set of controls, such as a known position of entryinto the treatment room 922, a known vector into the treatment room 922,a first known field applied in the first axis control 143, and/or asecond known field applied in the second axis control 144. Further, asdescribed, supra, a reference zero point or zero point 1002 is a pointon the reference beam path. More generally, the reference beam path andthe reference zero point optionally refer to a mathematical transform ofa calibrated reference beam path and a calibrated reference zero pointof the beam path, such as a charged particle beam path defined axissystem. The calibrated reference zero point is any point; however,preferably the reference zero point is on the calibrated reference beampath and as used herein, for clarity of presentation and without loss ofgenerality, is a point on the calibrated reference beam path crossing aplane defined by a terminus of the nozzle of the nozzle system 146.Optionally and preferably, the reference beam path is calibrated, in aprior calibration step, against one or more system position markers as afunction of one or more applied fields of the first known field and thesecond known field and optionally energy and/or flux/intensity of thecharged particle beam, such as along the treatment beam path 269. Thereference beam path is optionally and preferably implemented with afiducial marker system and is further described infra.

Example I

In a first example, referring still to FIG. 11, the charged particlereference beam path system 1100 is further described using a radiationtreatment plan developed using a traditional isocenter axis system 1122.A medical doctor approved radiation treatment plan 1110, such as aradiation treatment plan developed using the traditional isocenter axissystem 1122, is converted to a radiation treatment plan using thereference beam path—reference zero point treatment plan. The conversionstep, when coupled to a calibrated reference beam path, uses an idealisocenter point; hence, subsequent treatment using the calibratedreference beam and fiducial indicators 1140 removes the isocenter volumeerror. For instance, prior to tumor treatment 1170, fiducial indicators1140 are used to determine position of the patient 230 and/or todetermine a clear treatment path to the patient 230. For instance, thereference beam path and/or treatment beam path 269 derived therefrom isprojected in software to determine if the treatment beam path 269 isunobstructed by equipment in the treatment room using known geometriesof treatment room objects and fiducial indicators 1140 indicatingposition and/or orientation of one or more and preferably all movabletreatment room objects. The software is optionally implemented in avirtual treatment system. Preferably, the software system verifies aclear treatment path, relative to the actual physical obstacles markedwith the fiducial indicators 1140, in the less than 5, 4, 3, 2, 1,and/or 0.1 seconds prior to each use of the treatment beam path 269and/or in the less than 5, 4, 3, 2, 1, and/or 0.1 seconds followingmovement of the patient positioning system, patient 230, and/oroperator.

Example II

In a second example, referring again to FIG. 11, the charged particlereference beam path system 1100 is further described.

Generally, a radiation treatment plan is developed 1120. In a firstcase, an isocenter axis system 1122 is used to develop the radiationtreatment plan 1120. In a second case, a system using the reference beampath of the charged particles 1124 is used to develop the radiationtreatment plan. In a third case, the radiation treatment plan developedusing the reference beam path 1120 is converted to an isocenter axissystem 1122, to conform with traditional formats presented to themedical doctor, prior to medical doctor approval of the radiationtreatment plan 1110, where the transformation uses an actual isocenterpoint and not a mechanically defined isocenter volume and errorsassociated with the size of the volume, as detailed supra. In any case,the radiation treatment plan is tested, in software and/or in a dry runabsent tumor treatment, using the fiducial indicators 1140. The dry runallows a real-life error check to ensure that no mechanical elementcrosses the treatment beam in the proposed or developed radiationtreatment plan 1120. Optionally, a physical dummy placed in a patienttreatment position is used in the dry run.

After medical doctor approval of the radiation treatment plan 1110,tumor treatment 1170 commences, optionally and preferably with anintervening step of verifying a clear treatment path 1152 using thefiducial indicators 1140. In the event that the main controller 110determines, using the reference beam path and the fiducial indicators1140, that the treatment beam 269 would intersect an object or operatorin the treatment room 922, multiple options exist. In a first case, themain controller 110, upon determination of a blocked and/or obscuredtreatment path of the treatment beam 269, temporarily or permanentlystops the radiation treatment protocol. In a second case, optionallyafter interrupting the radiation treatment protocol, a modifiedtreatment plan is developed 1154 for subsequent medical doctor approvalof the modified radiation treatment plan 1110. In a third case,optionally after interrupting the radiation treatment protocol, aphysical transformation of a delivery axis system is performed 1130,such as by moving the nozzle system 146, rotating and/or translating thenozzle position 1134, and/or switching to another beamline 1136.Subsequently, tumor treatment 1170 is resumed and/or a modifiedtreatment plan is presented to the medical doctor for approval of theradiation treatment plan.

Automated Cancer Therapy Imaging/Treatment System

Cancer treatment using positively charged particles involvesmulti-dimensional imaging, multi-axes tumor irradiation treatmentplanning, multi-axes beam particle beam control, multi-axes patientmovement during treatment, and intermittently intervening objectsbetween the patient and/or the treatment nozzle system. Automation ofsubsets of the overall cancer therapy treatment system using robust codesimplifies working with the intermixed variables, which aids oversightby medical professionals. Herein, an automated system is optionallysemi-automated, such as overseen by a medical professional.

Example I

In a first example, referring still to FIG. 11 and referring now to FIG.12, a first example of a semi-automated cancer therapy treatment system1200 is described and the charged particle reference beam path system1100 is further described. The charged particle reference beam pathsystem 1100 is optionally and preferably used to automatically orsemi-automatically: (1) identify an upcoming treatment beam path; (2)determine presence of an object in the upcoming treatment beam path;and/or (3) redirect a path of the charged particle beam to yield analternative upcoming treatment beam path. Further, the main controller110 optionally and preferably contains a prescribed tumor irradiationplan, such as provided by a prescribing doctor. In this example, themain controller 110 is used to determine an alternative treatment planto achieve the same objective as the prescribed treatment plan. Forinstance, the main controller 110, upon determination of the presence ofan intervening object in an upcoming treatment beam path or imminenttreatment path directs and/or controls: movement of the interveningobject; movement of the patient positioning system; and/or position ofthe nozzle system 146 to achieve identical or substantially identicaltreatment of the tumor 220 in terms of radiation dosage per voxel and/ortumor collapse direction, where substantially identical is a dosageand/or direction within 90, 95, 97, 98, 99, or 99.5 percent of theprescription. Herein, an imminent treatment path is the next treatmentpath of the charged particle beam to the tumor in a current version of aradiation treatment plan and/or a treatment beam path/vector that isscheduled for use within the next 1, 5, 10, 30, or 60 seconds. In afirst case, the revised tumor treatment protocol is sent to a doctor,such as a doctor in a neighboring control room and/or a doctor in aremote facility or outside building, for approval. In a second case, thedoctor, present or remote, oversees an automated or semi-automatedrevision of the tumor treatment protocol, such as generated using themain controller. Optionally, the doctor halts treatment, suspendstreatment pending an analysis of the revised tumor treatment protocol,slows the treatment procedure, or allows the main controller to continuealong the computer suggested revised tumor treatment plan. Optionallyand preferably, imaging data and/or imaging information, such asdescribed supra, is input to the main controller 110 and/or is providedto the overseeing doctor or the doctor authorizing a revised tumortreatment irradiation plan.

Example II

Referring now to FIG. 12, a second example of the semi-automated cancertherapy treatment system 1200 is described. Initially, a medical doctor,such as an oncologist, provides an approved radiation treatment plan1210, which is implemented in a treatment step of delivering chargedparticles 1228 to the tumor 220 of the patient 230. Concurrent withimplementation of the treatment step, additional data is gathered, suchas via an updated/new image from an imaging system and/or via thefiducial indicators 1140. Subsequently, the main controller 110optionally, in an automated process or semi-automated process, adjuststhe provided doctor approved radiation treatment plan 1210 to form acurrent radiation treatment plan. In a first case, cancer treatmentshalts until the doctor approves the proposed/adjusted treatment plan andcontinues using the now, doctor approved, current radiation treatmentplan. In a second case, the computer generated radiation treatment plancontinues in an automated fashion as the current treatment plan. In athird case, the computer generated treatment plan is sent for approval,but cancer treatment proceeds at a reduced rate to allow the doctor timeto monitor the changed plan. The reduced rate is optionally less than100, 90, 80, 70, 60, or 50 percent of the original treatment rate and/oris greater than 0, 10, 20, 30, 40, or 50 percent of the originaltreatment rate. At any time, the overseeing doctor, medicalprofessional, or staff may increase or decrease the rate of treatment.

Example III

Referring still to FIG. 12, a third example of the semi-automated cancertherapy treatment system 1200 is described. In this example, a processof semi-autonomous cancer treatment 1220 is implemented. In starkcontrast with the previous example where a doctor provides the originalcancer treatment plan 1210, in this example the cancer therapy system110 auto-generates a radiation treatment plan 1226. Subsequently, theauto-generated treatment plan, now the current radiation treatment plan,is implemented, such as via the treatment step of delivering chargedparticles 1228 to the tumor 220 of the patient 230. Optionally andpreferably, the auto-generated radiation treatment plan 1226 is reviewedin an intervening and/or concurrent doctor oversight step 1230, wherethe auto-generated radiation treatment plan 1226 is approved as thecurrent treatment plan 1232 or approved as an alternative treatment plan1234; once approved referred to as the current treatment plan.

Generally, the original doctor approved treatment plan 1210, the autogenerated radiation treatment plan 1226, or the altered treatment plan1234, when being implemented is referred to as the current radiationtreatment plan.

Example IV

Referring still to FIG. 12, a fourth example of the semi-automatedcancer therapy treatment system 1200 is described. In this example, thecurrent radiation treatment plan, prior to implementation of aparticular set of voxels of the tumor 220 of the patient 230, isanalyzed in terms of clear path analysis, as described supra. Moreparticularly, fiducial indicators 1140 are used in determination of aclear treatment path prior to treatment along an imminent beam treatmentpath to one or more voxels of the tumor 220 of the patient. Uponimplementation, the imminent treatment vector is the treatment vector inthe deliver charged particles step 1228.

Example V

Referring still to FIG. 12, a fifth example of the semi-automated cancertherapy treatment system 1200 is described. In this example, a cancertreatment plan is generated semi-autonomously or autonomously using themain controller 110 and the process of semi-autonomous cancer treatmentsystem. More particularly, the process of semi-autonomous cancertreatment 1220 uses input from: (1) a semi-autonomously patientpositioning step 1222; (2) a semi-autonomous tumor imaging step 1224,and/or for the fiducial indicators 1140; and/or (3) a software coded setof radiation treatment directives with optional weighting parameters.For example, the treatment directives comprise a set of criteria to: (1)treat the tumor 220; (2) while reducing energy delivery of the chargedparticle beam outside of the tumor 220; minimizing or greatly reducingpassage of the charged particle beam into a high value element, such asan eye, nerve center, or organ, the process of semi-autonomous cancertreatment 1220 optionally auto-generates the original radiationtreatment plan 1226. The auto-generated original radiation treatmentplan 1226 is optionally auto-implemented, such as via the delivercharged particles step 1226, and/or is optionally reviewed by a doctor,such as in the doctor oversight 1230 process, described supra.Optionally and preferably, the semi-autonomous imaging step 1224generates and/or uses data from: (1) one or more proton scans from animaging system using protons to image the tumor 220; (2) one or moreX-ray images using one or more X-ray imaging systems; (3) a positronemission system; (4) a computed tomography system; and/or (5) anyimaging technique or system described herein.

The inventor notes that traditionally days pass between imaging thetumor and treating the tumor while a team of oncologists develop aradiation plan. In stark contrast, using the autonomous imaging andtreatment steps described herein, such as implemented by the maincontroller 110, the patient optionally remains in the treatment roomand/or in a treatment position in a patient positioning system from thetime of imaging, through the time of developing a radiation plan, andthrough at least a first tumor treatment session.

Example VI

Referring still to FIG. 12, a sixth example of the semi-automated cancertherapy treatment system 1200 is described. In this example, the delivercharged particle step 1228, using a current radiation treatment plan, isadjusted autonomously or semi-autonomously using concurrent and/orinterspersed images from the semi-autonomously imaging system 1224 asinterpreted, such as via the process of semi-automated cancer treatment1220 and input from the fiducial indicators 1140 and/or thesemi-automated patient position system 1222.

Referring now to FIG. 13, a system for developing a radiation treatmentplan 1310 using positively charged particles is described. Moreparticularly, a semi-automated radiation treatment plan developmentsystem 1300 is described, where the semi-automated system is optionallyfully automated or contains fully automated sub-processes.

The computer implemented algorithm, such as implemented using the maincontroller 110, in the automated radiation treatment plan developmentsystem 1300 generates a score, sub-score, and/or output to rank a set ofauto-generated potential radiation treatment plans, where the score isused in determination of a best radiation treatment plan, a proposedradiation treatment plan, and/or an auto-implemented radiation treatmentplan.

Still referring to FIG. 13, the semi-automated or automated radiationtreatment plan development system 1300 optionally and preferablyprovides a set of inputs, guidelines, and/or weights to a radiationtreatment development code that processes the inputs to generate anoptimal radiation treatment plan and/or a preferred radiation treatmentplan based upon the inputs, guidelines, and/or weights. An input is agoal specification, but not an absolute fixed requirement. Input goalsare optionally and preferably weighted and/or are associated with a hardlimit. Generally, the radiation treatment development code uses analgorithm, an optimization protocol, an intelligent system, computerlearning, supervised, and/or unsupervised algorithmic approach togenerating a proposed and/or immediately implemented radiation treatmentplan, which are compared via the score described above. Inputs to thesemi-automated radiation treatment plan development system 1300 includeimages of the tumor 220 of the patient 230, treatment goals, treatmentrestrictions, associated weights to each input, and/or associated limitsof each input. To facilitate description and understanding of theinvention, without loss of generality, optional inputs are illustratedin FIG. 13 and further described herein by way of a set of examples.

Example I

Still referring to FIG. 13, a first input to the semi-automatedradiation treatment plan development system 1300, used to generate theradiation treatment plan 1310, is a requirement of dose distribution1320. Herein, dose distribution comprises one or more parameters, suchas a prescribed dosage 1321 to be delivered; an evenness or uniformityof radiation dosage distribution 1322; a goal of reduced overall dosage1323 delivered to the patient 230; a specification related tominimization or reduction of dosage delivered to critical voxels 1324 ofthe patient 230, such as to a portion of an eye, brain, nervous system,and/or heart of the patient 230; and/or an extent of, outside aperimeter of the tumor, dosage distribution 1325. The automatedradiation treatment plan development system 1300 calculates and/oriterates a best radiation treatment plan using the inputs, such as via acomputer implemented algorithm.

Each parameter provided to the automated radiation treatment plandevelopment system 1300, optionally and preferably contains a weight orimportance. For clarity of presentation and without loss of generality,two cases illustrate.

In a first case, a requirement/goal of reduction of dosage or evencomplete elimination of radiation dosage to the optic nerve of the eye,provided in the minimized dosage to critical voxels 1324 input is givena higher weight than a requirement/goal to minimize dosage to an outerarea of the eye, such as the rectus muscle, or an inner volume of theeye, such as the vitreous humor of the eye. This first case is exemplaryof one input providing more than one sub-input where each sub-inputoptionally includes different weighting functions.

In a second case, a first weight and/or first sub-weight of a firstinput is compared with a second weight and/or a second sub-weight of asecond input. For instance, a distribution function, probability, orprecision of the even radiation dosage distribution 1322 inputoptionally comprises a lower associated weight than a weight providedfor the reduce overall dosage 1323 input to prevent the computeralgorithm from increasing radiation dosage in an attempt to yield anentirely uniform dose distribution.

Each parameter and/or sub-parameter provided to the automated radiationtreatment plan development system 1300, optionally and preferablycontains a limit, such as a hard limit, an upper limit, a lower limit, aprobability limit, and/or a distribution limit. The limit requirement isoptionally used, by the computer algorithm generating the radiationtreatment plan 1310, with or without the weighting parameters, describedsupra.

Example II

Still referring to FIG. 13, a second input to the semi-automatedradiation treatment plan development system 1300, is a patient motion1330 input. The patient motion 1330 input comprises: a move the patientin one direction 1332 input, a move the patient at a uniform speed 1333input, a total patient rotation 1334 input, a patient rotation rate 1335input, and/or a patient tilt 1336 input. For clarity of presentation andwithout loss of generality, the patient motion inputs are furtherdescribed, supra, in several cases.

Still referring to FIG. 13, in a first case the automated radiationtreatment plan development system 1300, provides a guidance input, suchas the move the patient in one direction 1332 input, but a furtherassociated directive is if other goals require it or if a better overallscore of the radiation treatment plan 1310 is achieved, the guidanceinput is optionally automatically relaxed. Similarly, the move thepatient at a uniform rate 1333 input is also provided with a guidanceinput, such as a low associated weight that is further relaxable toyield a high score, of the radiation treatment plan 1310, but is onlyrelaxed or implemented an associated fixed or hard limit number oftimes.

Still referring to FIG. 13, in a second case the computer implementedalgorithm, in the automated radiation treatment plan development system1300, optionally generates a sub-score. For instance, a patient comfortscore optionally comprises a score combining a metric related to two ormore of: the move the patient in one direction 1332 input, the move thepatient at a uniform rate 1333 input, the total patient rotation 1334input, the patient rotation rate 1335 input, and/or the reduce patienttilt 1336 input. The sub-score, which optionally has a preset limit,allows flexibility, in the computer implemented algorithm, to yield onpatient movement parameters as a whole, again to result in patientcomfort.

Still referring to FIG. 13, in a third case the automated radiationtreatment plan development system 1300 optionally contains an input usedfor more than one sub-function. For example, a reduce treatment time1331 input is optionally used as a patient comfort parameter and alsolinks into the dose distribution 1320 input.

Example III

Still referring to FIG. 13, a third input to the automated radiationtreatment plan development system 1300 comprises output of an imagingsystem, such as any of the imaging systems described herein.

Example IV

Still referring to FIG. 13, a fourth optional input to the automatedradiation treatment plan development system 1300 is structural and/orphysical elements present in the treatment room 922. Again, for clarityof presentation and without loss of generality, two cases illustratetreatment room object information as an input to the automateddevelopment of the radiation treatment plan 1310.

Still referring to FIG. 13, in a first case the automated radiationtreatment plan development system 1300 is optionally provided with apre-scan of potentially intervening support structures 1382 input, suchas a patient support device, a patient couch, and/or a patient supportelement, where the pre-scan is an image/density/redirection impact ofthe support structure on the positively charged particle treatment beam.Preferably, the pre-scan is an actual image or tomogram of the supportstructure using the actual facility synchrotron, a remotely generatedactual image, and/or a calculated impact of the intervening structure onthe positively charge particle beam. Determination of impact of thesupport structure on the charged particle beam is further described,infra.

Still referring to FIG. 13, in a second case the automated radiationtreatment plan development system 1300 is optionally provided with areduce treatment through a support structure 1344 input. As describedsupra, an associated weight, guidance, and/or limit is optionallyprovided with the reduce treatment through the support structure 1344input and, also as described supra, the support structure input isoptionally compromised relative to a more critical parameter, such asthe deliver prescribed dosage 1321 input or the minimize dosage tocritical voxels 1324 of the patient 230 input.

Example V

Still referring to FIG. 13, a fifth optional input to the automatedradiation treatment plan development system 1300 is a doctor input 1236,such as provided only prior to the auto generation of the radiationtreatment plan. Separately, doctor oversight 1230 is optionally providedto the automated radiation treatment plan development system 1300 asplans are being developed, such as an intervention to restrict anaction, an intervention to force an action, and/or an intervention tochange one of the inputs to the automated radiation treatment plandevelopment system 1300 for a radiation plan for a particularindividual.

Example VI

Still referring to FIG. 13, a sixth input to the automated radiationtreatment plan development system 1300 comprises information related tocollapse and/or shifting of the tumor 220 of the patient 230 duringtreatment. For instance, the radiation treatment plan 1310 isautomatically updated, using the automated radiation treatment plandevelopment system 1300, during treatment using an input of images ofthe tumor 220 of the patient 230 collected concurrently with treatmentusing the positively charged particles. For instance, as the tumor 220reduces in size with treatment, the tumor 220 collapses inward and/orshifts. The auto-updated radiation treatment plan is optionallyauto-implemented, such as without the patient moving from a treatmentposition. Optionally, the automated radiation treatment plan developmentsystem 1300 tracks dosage of untreated voxels of the tumor 220 and/ortracks partially irradiated, relative to the prescribed dosage 1321,voxels and dynamically and/or automatically adjusts the radiationtreatment plan 1310 to provide the full prescribed dosage to each voxeldespite movement of the tumor 220. Similarly, the automated radiationtreatment plan development system 1300 tracks dosage of treated voxelsof the tumor 220 and adjusts the automatically updated tumor treatmentplan to reduce and/or minimize further radiation delivery to the fullytreated and shifted tumor voxels while continuing treatment of thepartially treated and/or untreated shifted voxels of the tumor 220.

Automated Adaptive Treatment

Referring now to FIG. 14, a system for automatically updating theradiation treatment plan 1400 and preferably automatically updating andimplementing the radiation treatment plan is illustrated. In a firsttask 1410, an initial radiation treatment plan is provided, such as theauto-generated radiation treatment plan 1226, described supra. The firsttask is a startup task of an iterative loop of tasks and/or recurringset of tasks, described herein as comprising tasks two to four.

In a second task 1420, the tumor 220 is treated using the positivelycharged particles delivered from the synchrotron 130. In a third task1430, changes in the tumor shape and/or changes in the tumor positionrelative to surrounding constituents of the patient 230 are observed,such as via any of the imaging systems described herein. The imagingoptionally occurs simultaneously, concurrently, periodically, and/orintermittently with the second task while the patient remains positionedby the patient positioning system. The main controller 110 uses imagesfrom the imaging system(s) and the provided and/or current radiationtreatment plan to determine if the treatment plan is to be followed ormodified. Upon detected relative movement of the tumor 220 relative tothe other elements of the patient 230 and/or change in a shape of thetumor 230, a fourth task 1440 of updating the treatment plan isoptionally and preferably automatically implemented and/or use of theradiation treatment plan development system 1300, described supra, isimplemented. The process of tasks two to four is optionally andpreferably repeated n times where n is a positive integer of greaterthan 1, 2, 5, 10, 20, 50, or 100 and/or until a treatment session of thetumor 220 ends and the patient 230 departs the treatment room 922.

Automated Treatment

Referring now to FIG. 15, an automated cancer therapy treatment system1500 is illustrated. In the automated cancer therapy treatment system1500, a majority of tasks are implemented according to a computer basedalgorithm and/or an intelligent system. Optionally and preferably, amedical professional oversees the automated cancer therapy treatmentsystem 1500 and stops or alters the treatment upon detection of an errorbut fundamentally observes the process of computer algorithm guidedimplementation of the system using electromechanical elements, such asany of the hardware and/or software described herein. Optionally andpreferably, each sub-system and/or sub-task is automated. Optionally,one or more of the sub-systems and/or sub-tasks are performed by amedical professional. For instance, the patient 230 is optionallyinitially positioned in the patient positioning system by the medicalprofessional and/or the nozzle system 146 inserts are loaded by themedical professional. Optional and preferably automated, such ascomputer algorithm implemented, sub-tasks include one or more andpreferably all of:

receiving the treatment plan input 1300, such as a prescription,guidelines, patient motion guidelines 1330, dose distribution guidelines1320, intervening object 1310 information, and/or images of the tumor220;

using the treatment plan input 1300 to auto-generate a radiationtreatment plan 1226;

auto-positioning 1222 the patient 230;

auto-imaging 1224 the tumor 220;

implementing medical profession oversight 1238 instructions;

auto-implementing the radiation treatment plan 1420/delivering thepositively charged particles to the tumor 220;

auto-reposition the patient 1421 for subsequent radiation delivery;

auto-rotate a nozzle position 1422 of the nozzle system 146 relative tothe patient 230;

auto-translate a nozzle position 1423 of the nozzle system 146 relativeto the patient 230;

auto-verify a clear treatment path using an imaging system, such as toobserve presence of a metal object or unforeseen dense object via anX-ray image;

auto-verify a clear treatment path using fiducial indicators 1424;

auto control a state of the positively charge particle beam 1425, suchas energy, intensity, position (x,y,z), duration, and/or direction;

auto-control a particle beam path 1426, such as to a selected beamlineand/or to a selected nozzle;

auto implement positioning a tray insert and/or tray assembly;

auto-update a tumor image 1510;

auto-observe tumor movement 1430; and/or

generate an auto-modified radiation treatment plan 1440/new treatmentplan.

Still yet another embodiment includes any combination and/or permutationof any of the elements described herein.

The main controller, a localized communication apparatus, and/or asystem for communication of information optionally comprises one or moresubsystems stored on a client. The client is a computing platformconfigured to act as a client device or other computing device, such asa computer, personal computer, a digital media device, and/or a personaldigital assistant. The client comprises a processor that is optionallycoupled to one or more internal or external input device, such as amouse, a keyboard, a display device, a voice recognition system, amotion recognition system, or the like. The processor is alsocommunicatively coupled to an output device, such as a display screen ordata link to display or send data and/or processed information,respectively. In one embodiment, the communication apparatus is theprocessor. In another embodiment, the communication apparatus is a setof instructions stored in memory that is carried out by the processor.

The client includes a computer-readable storage medium, such as memory.The memory includes, but is not limited to, an electronic, optical,magnetic, or another storage or transmission data storage medium capableof coupling to a processor, such as a processor in communication with atouch-sensitive input device linked to computer-readable instructions.Other examples of suitable media include, for example, a flash drive, aCD-ROM, read only memory (ROM), random access memory (RAM), anapplication-specific integrated circuit (ASIC), a DVD, magnetic disk, anoptical disk, and/or a memory chip. The processor executes a set ofcomputer-executable program code instructions stored in the memory. Theinstructions may comprise code from any computer-programming language,including, for example, C originally of Bell Laboratories, C++, C#,Visual Basic® (Microsoft, Redmond, Wash.), Matlab® (MathWorks, Natick,Mass.), Java® (Oracle Corporation, Redwood City, Calif.), andJavaScript® (Oracle Corporation, Redwood City, Calif.).

Herein, any number, such as 1, 2, 3, 4, 5, is optionally more than thenumber, less than the number, or within 1, 2, 5, 10, 20, or 50 percentof the number.

Herein, an element and/or object is optionally manually and/ormechanically moved, such as along a guiding element, with a motor,and/or under control of the main controller.

The particular implementations shown and described are illustrative ofthe invention and its best mode and are not intended to otherwise limitthe scope of the present invention in any way. Indeed, for the sake ofbrevity, conventional manufacturing, connection, preparation, and otherfunctional aspects of the system may not be described in detail.Furthermore, the connecting lines shown in the various figures areintended to represent exemplary functional relationships and/or physicalcouplings between the various elements. Many alternative or additionalfunctional relationships or physical connections may be present in apractical system.

In the foregoing description, the invention has been described withreference to specific exemplary embodiments; however, it will beappreciated that various modifications and changes may be made withoutdeparting from the scope of the present invention as set forth herein.The description and figures are to be regarded in an illustrativemanner, rather than a restrictive one and all such modifications areintended to be included within the scope of the present invention.Accordingly, the scope of the invention should be determined by thegeneric embodiments described herein and their legal equivalents ratherthan by merely the specific examples described above. For example, thesteps recited in any method or process embodiment may be executed in anyorder and are not limited to the explicit order presented in thespecific examples. Additionally, the components and/or elements recitedin any apparatus embodiment may be assembled or otherwise operationallyconfigured in a variety of permutations to produce substantially thesame result as the present invention and are accordingly not limited tothe specific configuration recited in the specific examples.

Benefits, other advantages and solutions to problems have been describedabove with regard to particular embodiments; however, any benefit,advantage, solution to problems or any element that may cause anyparticular benefit, advantage or solution to occur or to become morepronounced are not to be construed as critical, required or essentialfeatures or components.

As used herein, the terms “comprises”, “comprising”, or any variationthereof, are intended to reference a non-exclusive inclusion, such thata process, method, article, composition or apparatus that comprises alist of elements does not include only those elements recited, but mayalso include other elements not expressly listed or inherent to suchprocess, method, article, composition or apparatus. Other combinationsand/or modifications of the above-described structures, arrangements,applications, proportions, elements, materials or components used in thepractice of the present invention, in addition to those not specificallyrecited, may be varied or otherwise particularly adapted to specificenvironments, manufacturing specifications, design parameters or otheroperating requirements without departing from the general principles ofthe same.

Although the invention has been described herein with reference tocertain preferred embodiments, one skilled in the art will readilyappreciate that other applications may be substituted for those setforth herein without departing from the spirit and scope of the presentinvention. Accordingly, the invention should only be limited by theClaims included below.

1. A method for reducing a kinetic energy of positively chargedparticles, comprising the steps of: transporting the positively chargedparticles from an accelerator, along a beam line, and into an exitnozzle system; providing a first chamber of said exit nozzle system,said first chamber comprising: an incident side comprising an incidentaperture; an exit side comprising an exit aperture; and a beam path ofthe positively charged particles from the incident aperture to the exitaperture; filling the beam path in said chamber with a liquid; and usingthe liquid to reduce the kinetic energy of the positively chargedparticles.
 2. The method of claim 1, further comprising the step of:dissipating radioactivity of the liquid using a pump to move a secondvolume of the liquid into said first chamber.
 3. The method of claim 1,further comprising the step of: changing a pathlength of the beam pathbetween the incident aperture and the exit aperture by moving said firstchamber radially across a longitudinal axis of the positively chargedparticles.
 4. The method of claim 3, said step of changing thepathlength further comprising the step of: increasing the pathlength ofthe beam path between the incident aperture and the exit aperture,wherein an additional volume of the liquid in the beam path functions toslow the positively charged particles.
 5. The method of claim 4, furthercomprising the step of: co-moving said first chamber and an exit nozzleof said exit nozzle system about a cancer patient position in atreatment room.
 6. The method of claim 4, further comprising the stepsof: providing a second chamber of said exit nozzle system; andtransmitting the positively charged particles through a fluid of saidsecond chamber.
 6. The method of claim 6, further comprising the stepof: altering a mean incident path of the positively charged particlespassing through the incident aperture to a mean deflected path usingsaid first chamber; and altering the mean deflected path of thepositively charged particles toward the mean incident path using saidsecond chamber.
 8. The method of claim 3, further comprising the stepof: replacing the liquid in the beam path between the incident apertureand the exit aperture with a gas; and after said step of replacing,using the positively charged particles in a cancer therapy system. 9.The method of claim 8, further comprising the step of: alternating saidsteps of: (1) filling the beam path with the liquid and (2) replacingthe liquid in the beam path between the incident aperture and the exitaperture with a gas.
 10. The method of claim 3, further comprising thestep of: determining a first axis position of the positively chargedparticles using a first ionization strip detector, said first ionizationstrip detector comprising a first element of a water tight seal over theincident aperture.
 11. The method of claim 10, further comprising thestep of: determining a second axis position, orthogonal to the firstaxis position, of the positively charged particles using a secondionization strip detector, said second ionization strip detectorproximate and within one inch of said first ionization strip detector.12. An apparatus for reducing a kinetic energy of positively chargedparticles, comprising: an exit nozzle system linked to an accelerator bya beam line, wherein the positively charged particles move from saidaccelerator, along said beam line, and into said exit nozzle systemduring use; a first chamber of said exit nozzle system, said firstchamber comprising: an incident side comprising an incident aperture; anexit side comprising an exit aperture; and a beam path of the positivelycharged particles from the incident aperture to the exit aperture,wherein a liquid in the beam path reduces the kinetic energy of thepositively charged particles during use.
 13. The apparatus of claim 12,said first chamber further comprising: a non-uniform distance betweensaid incident side and said exit side.
 14. The apparatus of claim 13,further comprising: a first motor configured to move said first chamberradially through a longitudinal axis of the positively chargedparticles.
 15. The apparatus of claim 14, further comprising: a secondchamber of said exit nozzle system positioned in a path of thepositively charged particles.
 16. The apparatus of claim 14, furthercomprising: a second motor configured to move said second chamberradially through the longitudinal axis of the positively chargedparticles; and a main controller configured to direct movement of saidfirst chamber in a first direction and movement of said second chamberin a second direction opposite said first direction as a function oftime.
 17. The apparatus of claim 12, said second chamber furthercomprising: a shape matching said first chamber, said second chamberrotated one hundred eighty degrees in the beam path relative to saidfirst chamber.
 18. The apparatus of claim 12, further comprising: afirst ionization strip detector comprising an element of a seal over theincident aperture, said first ionization strip detector configured to,responsive to passage of the positively charged particles, emitelectrons used to determine a first axis position of the positivelycharged particles.
 19. The apparatus of claim 18, further comprising: asecond ionization strip detector proximate said first ionization stripdetector, first longitudinal strips of said second ionization stripdetector orthogonal to second longitudinal strips of said firstionization detector.